MCW/AT-LAN-TEC Inc.

16021 INDUSTRIAL DR., STE. 12

GAITHERSBURG, MD 20877

301-590-9090 fax 301-948-0658

APPLICATION FOR CREDIT:

COMPANY NAME______________________________________________________ § CUSTOMER ACCT#__________

§ AMOUNT OF CREDIT:_______

SHIPPING ADDRESS___________________________________________________  COD CERTIFIED  CASH

 COD COMPANY CHECK

City: ___________________________ State: ______________________ Zip:________

MAILING ADDRESS:________________________________  NET TERMS

City: ___________________________ State: ______________________ Zip:________

PHONE NUMBER:___________________________________

FAX # :___________________________________

FORM OF BUSINESS: CORPORATION___ SOLE PROPRIETOR__ PARTNERSHIP__

DATE BUSINESS ESTABLISHED: ______ TAX RESALE #_________________________

NATURE OF BUSINESS:_____________________________FEDERAL I.D.#_______________

DUN & BRAD STREET #________________________

PRINCIPALS OF COMPANY:

NAME TITLE ADDRESS SOCIAL SECURITY #

_____________________________________________________________________________________________________

_____________________________________________________________________________________________________

BANK REFERENCE:

NAME:_____________________ ADDRESS:___________________________ OFFICER:__________

PHONE #______________________ ACCOUNT #___________________

TRADE REFERENCES:

1. NAME:_____________________ ADDRESS:________________________PHONE#:___________CONTACT:______________ TERMS:___________ HIGHEST CREDIT__________

2. NAME:_____________________ ADDRESS:________________________PHONE#:___________CONTACT:______________ TERMS:___________ HIGHEST CREDIT__________

3. NAME:_____________________ ADDRESS:_________________________PHONE#:__________CONTACT:______________ TERMS:___________ HIGHEST CREDIT__________

** This credit application is submitted in writing for the purpose of obtaining merchandise from you on credit. All information is true and correct.

** I do hereby agree to personally guarantee any and all debts incurred by the above captioned company from MCW/AT-LAN-TEC. In addition, I understand and agree to pay according to MCW/AT-LAN-TEC’s terms.

** I also agree to pay any and all expenses of collections, including attorney’s fees, and cost of litigation should the account become delinquent and determine such action necessary.

X_____________________________ _________ X____________________________ _______

Signature of Principle Date Signature of Witness Date