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The undersigned is applying for credit with Trailer Tech USA (the "Company") and agrees to abide by the terms and conditions of the Company's standard contract.
1. Company Name________________________________________________________________________
and Address ____________________________________________________________________________
2. Phone (_________ )_____________________ Fax (____________ )______________________________
3. Federal Tax ID or Social Security No._____________________________________________________
4. Type of Business No. of Employees ______________________________________________________
5. Date Business Established_______________________________________________________________
6. Types of Services You Will Purchase _____________________________________________________
7. Amount of Credit Requested $ ___________________________________________________________
8. Check which is applicable to you : _______Corporation [__] General Partnership [__] Other [__]___ ________________________________________Limited Partnership [___] LLC Sole Proprietorship [__]_
9. State where your company was organized :________________________________________________
10. Have you or any of your affiliates ever had credit with us before or purchased from us before? Yes ___ No
If yes, under what name? _________________________________________________________________________
11. Name or title of persons authorized to act on your behalf : _________________________________________
12. Trade References______________________________________________________________________________
Reference #1 Name and Address : _________________________________________________________________
Phone (__ ) ____________________________________________________________________________________
Reference #2 Name and Address : _________________________________________________________________
Phone (__ ) ____________________________________________________________________________________
Reference #3 Name and Address : _________________________________________________________________
Phone (__ ) _____________________________________________________________________________________
13. Bank References______________________________________________________________________________
Bank #1 Account # Phone (__ ) ____________________________________________________________________
Contact Person __________________________________________________________________________________
Name of Bank ___________________________________________________________________________________
Address ________________________________________________________________________________________
14. Have you or your officers or affiliates ever filed a petition in bankruptcy? ____________________________
15. Are you current in meeting your other financial obligations? _______________________________________

We declare that the above information is true, correct and complete and is given to induce the Company to extend credit.
We authorize the Company to make such credit investigation as the Company sees fit, including contacting the above trade references and banks and obtaining credit reports.

We authorize all trade references, banks and credit reporting agencies to disclose to the Company any and all information concerning the financial and credit history of my company and myself:

I have read the terms and conditions stated above and agree to all of those terms and conditions
Name of Company _______________________________________________________________________________
Authorized Signature : ____________________________________________________________________________
Printed Name : ___________________________________________________________________________________
Title : Date : _____________________________________________________________________________________

In consideration of the extension of credit by Trailer Tech, USA the undersigned agrees:

1. The above information is true and correct.________________________________________________________
2. To pay each invoice in full within thirty days of date of purchase, or to pay the statement balance in full by the 10th of the following month.
3. To pay late charges on any delinquent amounts at the rate of 1 ½% per month (18% per annum).__________
4. To pay all reasonable charges for collection, including attorney fees and court costs, if the account is_____ placed with an attorney or collection agency.
5. To provide Trailer Tech USA with a list of parties authorized to charge on this account.______________________
6. To permit Trailer Tech USA to contact any bank, supplier, or credit service necessary to establish and maintain_ the line of credit requested.
Company ________________________________ Authorized Signature ___________________________________
Title ____________________________________ Print Name_____________________________________________

Please return completed application to: Trailer Tech USA, PO Box 1293, Easthampton, MA 01027 fax 888-844-2913