One R.E. Michel Drive • Glen Burnie, MD 21060-6495 • (410) 760-4000 • Fax (410) 412-2593 www.remichel.com

R.E. MICHEL COMPANY INC.

CONFIDENTIAL CREDIT APPLICATION AND SALES AGREEMENT ALL INFORMATION MUST BE COMPLETED AND THIS APPLICATION MUST BE SIGNED IN INK ON THE REVERSE SIDE. (Incomplete forms will be returned.)

COMPANY USE ONLY Account # ______________ CR. Limit _______________ Branch ________________ Salesman_______________ Date___________________ Equifax_________________ D & B________ NACM _______

PG# ________

We take pride in our unconditional and full compliance with all provisions of the Equal Credit Opportunity Act and the Fair Credit Reporting Act. The ECOA prohibits creditors from discriminating against credit appli- cants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this credit application is the Federal Trade Commission, Division of Credit Practices, 6th and Pennsylvania Avenue, NW, Washington, D.C. 20580.

________________________________________________________________________________________ Full Legal Name of corporation, LLC, partnership or sole proprietorship (As on your business license or charter)

DBA or T/A_______________________________________________________________________________ (The name under which you do business)

Street ___________________________________________________________________________________ (If post office box, then also include street address)

City_____________________________________State______________ Zip Code______________________ Building is ■ Owned

County __________________________________ Business is:

■Corporation State of incorporation:________________ ■ Limited Liability Company ■ Partnership

■ Sole Proprietorship

_______________________________ _______________________________ _______________________________

■ Mechanical Contractor ■ Gas Heating Service & Installation ■ Oil Heating Service & Installation ■ Refrigeration Service & Installation

Social Security # _________________ _________________ _________________

■ Rented

Landlord ________________ Address _________________

List below the name of Officers, Partners, Managing Members, and/or Sole Proprietor Name

Home Address

Date business began_____________ Annual Sales ___________________ Phone ________________________ Fax __________________________ Email _________________________

Check box if:

■ You have ever declared bankruptcy ■ A company in which you have had ownership has ever declared bankruptcy

■ You have any pending lawsuits against you or your company

Home Phone Title

_________________________________ ______________ _________________ _________________________________ ______________ _________________ _________________________________ ______________ _________________

Please check the block or blocks that best indicate your type of business: Help Us to Help Y ■ Air Conditioning & Heat Pump Service & Installation

■ Military Agencies & Bases ■ Industrial or Manufacturing ■ Property Management

Number of Service/Installation Trucks:_____________

Bank Name __________________________________________________ Acct Name _________________________________________________ Street ______________________________________________ Phone __________________ Checking Acct. # __________________________

City/State______________________________________________________________________ Zip _____________________________________ Are Purchase Orders Required: Yes Tax exempt No ■ Yes

■ No ■ ■ Attach copy of certificate Requested credit availability, which may be increased or reduced at sole discretion of

R.E. Michel Company, Inc. $____________ Standard Terms of Sale: Net 10th prox. (Net due 10th of month following invoice date)

1.Name ___________________________________________________ 3.Name ______________________________________________________ City _______________________________State ______ Zip________

ou!

■ Boiler Service & Installation ■ Institutions (Colleges, hospitals, etc.) ■ Local, State, Federal Government Agency ■ Other_________________________________

City _______________________________State _________ Zip________

Account No. _________________ Phone # ___________________ Account No. Phone # ___________________ _____________________ Fax __________________ E-Mail ___________________________ Fax _____________________ E-Mail _____________________________

2.Name ___________________________________________________ 4.Name _______________________________________________________ City _______________________________State ______ Zip________

City _______________________________State _________ Zip________

Account No. __________________ Phone # ___________________ Account No. _____________________ Phone # ___________________ Fax __________________ E-Mail ___________________________ Fax _____________________ E-Mail _____________________________ Terms & Conditions on reverse

1S105 05/09

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