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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granted, may be withdrawn at any time.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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