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BUSINESS CREDIT APPLICATION FORM

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BUSINESS CREDIT APPLICATION
Business Name__________________________________Date______________
Address______________________City__________State_________Zip_____
Owner/Manager_______________________________Tel.No.______________
How long in business________________________D & B Rated__________
Trade References:
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Bank References:
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Credit line requested $_________________________________
Pending lawsuits against Company:
     ___________________________________________________
     ___________________________________________________
     ___________________________________________________


     The undersigned authorizes inquiry as to credit
information. We further acknowledge that credit privileges, if
granted, may be withdrawn at any time.

_______________________________

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