MAIL INVOICES TO:

__________________________________________________

__________________________________________________

__________________________________________________

_______SOLE PROPRIETORSHIP
_______PARTNERSHIP
_______CORPORATION (STATE)_______
_______OTHER

FEDERAL ID: _______________________________________

TAX EXEMPT: _______ YES _______ NO (IF YES PLEASE PROVIDE CERTIFICATE)

OWNERS, PARTNERS OR OFFICERS ARE: (NAME, TITLE, ADDRESS, PHONE)

1.)_________________________________________________

2.)_________________________________________________

3.)_________________________________________________

EQUIPMENT REFERENCES: (NAME, ADDRESS AND PHONE)

___________________________________________________

___________________________________________________

OTHER TRADE REFERENCES:

___________________________________________________

___________________________________________________

BANK REFERENCES: (NAME, ADDRESS AND ACCOUNT #)

___________________________________________________

___________________________________________________

SIGNATURE:_________________________________________

DATE: ________________

BY SIGNING, I AUTHORIZE RTL CORPORATION TO CHECK MY CREDIT RATINGS.