APPLICATION FOR CREDIT
COMPANY NAME_______________________________________						DATE ESTABLISHED__________________
MAILING ADDRESS_____________________________________						BUSINESS PHONE____________________
CITY_______________________			STATE________ ZIP__________			BUSINESS FAX_______________________
SHIPPING ADDRESS____________________________________						CITY________________________________
STATE________ ZIP__________			TYPE OF BUSINESS______________________________________________
WEBSITE___________________________________					E-MAIL_______________________________________
BUSINESS OWNERSHIP:     _____SOLE PROPRIERTORSHIP _____PARTNERSHIP _____CORPORATION
IS BUSINESS INCORPORATED?_________________					IF SO, UNDER WHAT STATE_____________________
BUSINESS LICENSE #__________________________					CONTRACTOR LICENSE #_______________________
SALES TAX STATUS
TAX EXEMPT:     ___NO     ___YES				IF YES, A SIGNED TAX EXCEMPT CERTIFICATE MUST BE ON FILE
OWNERS & OFFICERS
NAME________________________________________					NAME________________________________________
TITLE_________________________________________					TITLE_________________________________________
ADDRESS____________________________________					ADDRESS____________________________________
CITY, STATE, ZIP______________________________					CITY, STATE, ZIP______________________________
PHONE_______________________________________					PHONE_______________________________________
SOCIAL SECURITY #___________________________					SOCIAL SECURITY #___________________________
				BANK INFORMATION
BANK NAME__________________________________					CONTACT_____________________________________
ADDRESS____________________________________					PHONE_______________________________________
CITY, STATE, ZIP______________________________					ACCOUNT NUMBER____________________________
DO YOU PLEDGE OR BORROW ON YOUR ACCOUNTS RECEIVABLE_______________________________
IF YES, FROM WHOM________________________________________________________________________
Mailing Address: Post Office Box 1 w Harrisburg, North Carolina 28075
Warehouse Address:  4373 Triple Crown Drive w Concord, North Carolina 28027
Phone:  704-786-7785					Fax:  704-788-6702
TRADE REFERENCES
NAME________________________________________					NAME________________________________________
ADDRESS____________________________________					ADDRESS____________________________________
CITY, STATE, ZIP______________________________					CITY, STATE, ZIP______________________________
PHONE_______________________________________					PHONE_______________________________________
FAX__________________________________________					FAX__________________________________________
TERMS OF SALE
Net 30 days from date of invoice to customers with approved credit. Past due accounts will be COD. All past
due balances will be subject to a service charge of 1 1/2 % per month. In the event of default in payment, any
and all reasonable incurredcollection and attorney fees and court costs will be added to the balance.
Everything stated in this application is true and correct, and I authorize Appatek Industries, Inc. to request
credit related information from trade references, bank references and/or credit reporting agencies or bureaus.
____________________________________________					__________________________			________________
NAME					TITLE			DATE
PERSONAL GUARANTEE AGREEMENT
IN CONSIDERATION OF APPATEK INDUSTRIES, INC. AGREEING SO SELL GOODS ON OPEN ACCOUNT
TO_____________________________________________ ("BUYER"), I/WE , THE UNDERSIGNED, JOINTLY
AND SEVERALLY, HEREBY PERSONALLY GUARANTEE PAYMENT OF ANY AND ALL AMOUNTS AS
MAY HEREAFTER BE OWED TO APPATEK INDUSTRIES, INC. BY BUYER, WHETHER OR NOT SUCH
AMOUNTS EXCEED STATED CREDIT LIMITS, AND OF ALL LEGAL FEES AND EXPENSES INCURRED BY
APPATEK INDUSTRIES, INC. IN THE COLLECTION THEREOF. THIS SHALL BE A CONTINUING
UNCONDITIONAL PERSONAL GUARRANTY AND OBLIGATES ME/US WITH AND TO THE SAME EXTENT
AS BUYER, AND THESE OBLIGATIONS SHALL BE BINDING ON THE HEIRS, ADMINISTRATORS, SUCCE-
SSORS, AND ASSIGS OF THE UNDERSIGNED. THE UNDERSIGNED EXPRESSLY WAIVE NOTICE OF
ACCEPTANCE OF THIS GUARANTEE, AND PROMPTNESS, DEMAND, PROTEST, AND NOTICE OF DIS-
HONOR OF OBLIGATIONS HEREBY GUARANTEED. I/WE AUTHORIZE APPATEK INDUSTRIES, INC. TO
OBTAIN ANY PERSONAL CREDIT INFORMATION ABOUT BUYER OR GUARANTOR FROM ANY ENTITY.
GUARRANTEED BY:_____________________________________________							DATE______________________
GUARRANTEED BY:_____________________________________________							DATE______________________