DATE ___________________     ALL QUESTIONS MUST BE ANSWERED

ACCOUNT NAME: _____________________________________________

INDIVIDUAL ___ PARTNERSHIP ___ CORPORATION ___ OTHER ___
If a Corporation, officers must personally guarantee payment of account in space provided below

Business Address: _________________________________________________
      
Telephone #: ______________________
        
Type of Business: __________________________ Years in Business: _______

Have you or business ever had an account with us Before ?_____

TRADE REFERENCES:
NAME                   COMPLETE ADDRESS              PHONE #

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

BANK REFERENCE:
NAME OF BANK: ______________________ PHONE # ______________________

ACCOUNT TYPE _______________ ACCOUNT #________________________

ADDRESS OF BRANCH _________________________________________________

LIST NAME(S) ADDRESSES AND TELEPHONE NUMBERS OF OFFICERS OF
YOUR COMPANY ______________________________________________________

_____________________________________________________________________

I (WE) HEREBY INDIVIDUALLY AND JOINTLY GUARANTEE PAYMENT OF THIS ACCOUNT. THIS GUARANTEE CAN NOT BE CANCELED ORALLY. WE AGREE THAT IN THE EVENT OF NON-PAYMENT OF THIS ACCOUNT, WE WILL BE HELD LIABLE FOR A 25% FEE FOR COLLECTION OR LITIGATION, TOGETHER WITH 1+1/2% INTEREST PER MONTH.

________________________________   ____________________________
Signature of Guarantor     Signature of Guarantor

Print name :____________________   ____________________________

S.S. # _______-______-____________  S.S. # _______-______-____________