Firm Business Name: __________________________________

Billing Address: __________________________________

Phone: __________________

Fax: ____________________

Corporation: _________Yes ___________ No

Year Incorporated: _________

Partnership: ________Yes ____________ No

Sole Proprietor: ________ Yes _________No

Name Of Principal Owner: ________________________________

Address: ____________________ City _________________ State ___

Phone: __________________ Title: ______________________

I (WE) HAVE COMPLETED THIS APPLICATION TO OBTAIN, AND CERTIFY THAT ALL STATEMENTS CONTAINED THERE IN ARE TRUE AND CORRECT. I (WE) AGREE THAT CREDIT INQUIRIES MAY BE MADE AND AUTHORIZE THE RELEASE OF SUCH INFORMATION TO YOU. I (WE) UNDERSTAND AND AGREE THAT ANY CREDIT WE ACCUMULATE SHALL BE PAID PROMPTLY IN ACCORDANCE WITH THE CREDIT GRANTOR TERMS AND AGREEMENTS. I (WE) ALSO UNDERSTAND AND AGREE THAT CREDIT BALANCE NOT PAID IN ACCORDANCE WITH THE SAID TERM AND AGREEMENT. I (WE) ALSO AGREE, IN THE EVENT OF DEFAULT, TO PAY REASONABLE COLLECTION CHARGES, ATTORNEY FEES, AND COURT COSTS WHERE APPLICABLE.

SIGNED 1: ____________________________________________

SIGNED 2: ____________________________________________

PORTLAND DOOR CONTROLS, INC. TERMS: NET 30 DAYS