Credit Application

Application Date:

Full Legal Business Name:

(As it appears on Business License)

Business Address

Address 1:

Address 2:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Country:

USA Argentina Australia Austria Bahamas Belgium Brazil Bulgaria Canada Chile China Costa Rica Croatia Denmark El Salvador Finland France Germany Greece Hong Kong India Indonesia Ireland Israel Italy Japan Korea - Republic of (South) Lebanon Lithuania Luxembourg Malaysia Mexico New Zealand Norway Pakistan Philippines Portugal Russia Singapore Slovenia South Africa Spain Sweden Switzerland Taiwan Thailand The Netherlands Turkey UAE United Kingdom Venezuela

Contact:

List the Resale Exemption Numbers for each state the company is located.

Resale Tax Exemption #:

State: AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY

Expiration:

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Resale Tax Exemption #:

State: AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY

Expiration:

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Dunn & Bradstreet Number:

Customer Category:

Distributor Mill Other

Payment Terms

Terms Requested:

Cash In Advance Terms

Net Terms Requested:

Days

Credit Line Requested:

List 2 Company Officers

Officer 1:

Name:

Title:

Address 1:

Address 2:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Phone:

Officer 2:

Name:

Title:

Address 1:

Address 2:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Phone:

Accounts Payable Manager:

Name:

Address 1:

Address 2:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Phone:

Bank Information

Bank Name:

Account #:

Address 1:

Address 2:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Phone:

Fax:

Contact:

Trade References

Reference 1:

Company Name:

Address:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Phone:

Fax REQUIRED:

Reference 2:

Company Name:

Address:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Phone:

Fax REQUIRED:

Reference 3:

Company Name:

Address:

City:

State:

AB AK AL AZ BC CA CO CT DC DE FL GA HI IA IL IN KS KY LA MA MB MD MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK ON OR PA PR QC RI SC SD TN TX UT VA VT WA WI WV WY Zip:

Phone:

Fax REQUIRED:

Complete By:

Date:

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Title:

Phone Number:

Acceptance and Approval:

Checking this box acts as your digital signature and indicates your acceptance of
the Main Steel Polishing Company, Inc. Limited Warranty and Terms and Conditions
as stated. In addition you authorize Main Steel Polishing to make any and all inquiries necessary to process this credit application.