Page 5 - 2007-00-02

Application For Credit

Please fax to : 410-325-2240 (Page 1 of 2)

MIll Supply Company Inc. Moravia Industrial Park 6210 Frankford Avenue Baltimore, MD. 21206 Phone 410-485-3343

Purchaser(s) _________________________________________________ Phone # _____________________

Address ________________________________________ City _________________ State/Zip ___________

Check One

( ) Corporation ( ) Partnership ( ) Individual Building,Private Owner or Project

Officer, Partners or Spouse

Name Address Title Phone

1._________________________________________________________________________________ 2._________________________________________________________________________________ 3._________________________________________________________________________________

Year Established : _____________

Tax Status : ( ) Taxable ( ) Resale ( ) Tax Exempt #___________ Fax Certificate w/application

Trade References : (Please provide fax #’s)

Name Address Title Phone Fax

1._________________________________________________________________________________ 2._________________________________________________________________________________ 3._________________________________________________________________________________

Bank References :

Checking :______________________________________

Contact :_______________________________________Phone #_________________________________

Lines of Credit :_________________________________

Agreement :

It is understood that Mill Supply Company Inc. may impose a late fee of one and one-half (1-1/2) percent per month on any past due balances exceeding 30 days, and that the undersigned will pay all costs of collection and reasonable attorney’s fees of 20%. The undersigned agrees that if credit is granted by Mill Supply Co. the undersigned will be responsible for all invoices as presented. I (we) certify the above information above to be true and accurate. You hereby consent to venue in any such action in the District or Circuit Court for

Baltimore City, Maryland.

Signature _________________________________ Signature_________________________________

Location___________ Salesman__________

To be filled out by Mill Supply