TRIATEK Account Application (con't)

City/State/Zip:________________ Bank Phone Number:____________

Bank Fax Number:____________ Loan Officer to Contact: __________

Checking Account Number:________ Loan Account Number:________

Accounts Payable Bookkeeper:_________________

Credit References: Give only the names and addresses of those you buy from on open account. You may attach your credit references to this signed dealer application.

This credit application is given to secure open account credit on net 30 day terms. The information contained herein is correct, complete and true. The undersigned officer(s) authorizes TRIATEK permission to obtain credit information which will be kept strictly confidential. We agree to TRIATEK's Standard Terms and Conditions of Sale.