Lavallee & Ide Co. / Custanite Precision Inc. CREDIT APPLICATION 1889 Larchwood Dr. Date: Troy, MI 48083 PH: 800-451-5195 FAX: 248-989-0356 Web: http:/swww:lavallee-ide.com COMPANY INFORMATION: Company Name: Fax: Phone: City: State: Zip: Billing Address: City: State: Zip: Shipping Address Is this a residential address? 1 Yes 7 No Year Business Started. D&B Rating. Business is: ( Resale only 1) Other. Resale Exempt Number: Company President: Company Vice-President Home Address: Home Address: City/State/Zip: City/State/Zip Type of Business: Purchasing Agent: How did you learn about us? CREDIT REFERENCES: (please fill out completely so as not to delay processing) Name: Name: Address: Address: City/State/Zip: City/State/Zip: Telephone: Telephone: Fax. Fax! Name: Name: Address: Address: City/State/Zip: City/State/Zip Telephone: Telephone: Fax. Fax: BANKING INFORMATIO! Name: Credit Line Requested: Address City/State/Zip: Account No: Authorization is granted for above references and ‘Telephone: bank to disclose information to Lavallee & Ide Co. Fax for purposes of credit evaluation Contact Officer:, x ‘TERMS AND CONDITIONS: ‘TERMS ARE NET 30 DAYS. In the event the account is referred for collection, this company agrees to pay all costs of collection, including court costs and reasonable attomey fees. A secured interest is hereby granted Lavallee & Ide Co. for cutting tools which are purchased from them by the unsigned company. If any checks are returned due to non-sufficient funds all bank costs incurred will be charged back to your account, x x. Authorized Signature for the Company Signature of Company Officer