Credit Application                               Please return via fax at (614) 882-7312
Mindy Bendure - C.F.O
Net 30 Days - Credit Terms

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Company Name                                                                     Area Code Phone

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Address                                                                                 Years At Address

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City, State                                               Zip Code           Federal Tax ID Number

The following information must be provided and will be held strictly confidential.

____Corporation ____Incorporated in the past 12 months ____Partnership ____Individual

Name(s) of Principal(s) Complete Address Phone

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Bank                                           Address                                                                    Phone

Accounts Payable Contact ____________________________  Phone # _________________________

Do you require a monthly statement   _____Yes    ______No

 *Credit approval will be determined by your D & B Rating & responses from your references below:

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We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.