Account No. CREDIT APPLICATION Business Name: Business Address: City: State: Zip: Phone No: Fax No: Resale No: Date Business Started: Estimated Monthtly Purchases: We hereby apply for credit and certify that the information below is correct. Our understanding is that this information is for the use of your Credit Department only and will be held in strict confidence. This business is a (Check one): Sole Proprietorship Partnership Corporation List information for sole proprietor or all partners or corporation officers Name: Title: Address Home Phone: City: State: Zip: Name: Title: Address Home Phone: City: State: Zip: Name: Title: Address Home Phone: City: State: Zip: Bank References: Bank Name: Contact: Address Account No: City: State: Zip: Continued on reverse side. Page 1