CMA Supply Company, Incorporated

3201 Roosevelt Ave 3333 Independence Dr 1900 Watterson Tr 9984 Commerce Park Dr 910 W. Ireland Rd 5000 Angola Rd

Indianapolis, IN 46218 Fort Wayne, IN 46808 Louisville, KY 40299 Cincinnati, OH 45246 South Bend, IN 46614 Toledo, OH 43615

317-545-4446 260-471-9000 502-499-2221 513-942-6663 574-231-9000 419-776-9000

FAX 317-545-5631 FAX 260-471-4720 FAX 502-499-2241 FAX 513-942-7546 FAX 574-231-9188 FAX 419-776-1067

APPLICATION FOR CREDIT

NAME OF APPLICANT:__________________________________________________________________________________________________

BILLING ADDRESS (Street)________________________________________________________________ P. O. Box ______________________

City:______________________________________ State: _____ Zip: _________ Phone: ____________________ Fax:______________________

Website: ________________________________________________________________________________________________________________

Circle One: Corporation Partnership Proprietorship Personal Other (specify) ___________________________

Date Established: ________________ State Incorporated: _________ Tax ID/EIN: _________________________________________________

Tax Exempt? YES / NO #_________________________ Purchase Order Required? YES / NO Credit Limit Requested? $__________

A/P Contact: ______________________________________ Phone: ______________________________ Email: ___________________________

Purchasing Contact: ________________________________ Phone: ______________________________ Email: ___________________________

Receive emailed invoices/statements? YES / NO Email address:______________________________________________________________

OWNERS, OFFICERS, PRINCIPALS, PARTNERS:

Name Title Address Phone

________________________________________________________________________________________________________________________

BANK REFERENCE (attach a voided check)

Bank Name:_______________________________________________ City, State: _______________________________ Phone:______________________________

Account #:________________________________________________ Contact:__________________________________ Fax:_______________________________

Bonding Company: _________________________________________ Phone:___________________________________ Fax: _______________________________

TRADE REFERENCES

Name: ___________________________________________________ Phone: ___________________________________ Fax: _______________________________

TERMS OF PAYMENT: NET 30 from invoice date

A 1.5% per month service charge may be assessed on all unpaid balances. Applicant agrees to pay any & all collection costs or fees, including reasonable

attorneys’ fees, upon delinquency in the account in excess of 60 days & following written notification. Applicant consents to the jurisdiction of the county

court of the local office for resolution of any disputes arising out of any transactions.

Signature:_________________________________________________________________________________________ Date:_______________________________

Printed: ___________________________________________________________________________________________ Title: ______________________________

GUARANTY

The undersigned hereby agrees to personally guarantee payment of the above Applicant’s account, according to the terms of this Application for Credit, for all amounts charged:

(required for all entities in business for less than 2 years)

Signature:________________________________________________ SS #: ______________________________________ Date: ______________________________

Printed: _________________________________________________ Bank: ______________________________________ Account #: _________________________