DISTRIBUTOR START-UP PROPOSAL

511 Spruce Street | Suite 1 | Clearfield, PA 16830 1-800-528-5733 | www.hydrospray.com

APPLICATION FOR CREDIT

Incomplete credit applications will not be processed. No exceptions. 511 Spruce Street, Suite 1, Clearfield PA 16830

Ph: 800-528-5733 Fax: 888-223-4835 / Attn: Karen FulmerOr Email: kfulmer@hydrospray.com

Company Name: Phone #: Fax #:

Mailing Address: Shipping Address:

City/State/Zip: City/State/Zip:

Company Web Site: Company E-Mail:

Accounts Payable Contact: Phone#: E-Mail Address:

Hydro-Spray Wash Systems Contact:

Karen FulmerPhone#:

800-528-5733E-Mail Address:

kfulmer@hydrospray.com

Type of Ownership (circle one): Sole Proprietorship Partnership Corporation--Date of Inc. __________ State of __________

Date Company Established: Years at Present Location: Anticipated Monthly Purchases: Credit Limit Requested:

Average Monthly Sales: # Of Employees: Do You Require a P.O.: Building (leased or owned):

Resale #(Card must be on file for all states before any orders are placed): Federal I.D#: D & B#:

Names of Corporate Officers, Partners, or Owners:

Name: Position: % Ownership: D/L #: SS#:

Has this firm or any of its principals ever been bankrupt? ¨ Yes ¨ No If “Yes”, please explain:

Open Account References(please provide four references):Incorrect information or references that will not comply will greatly delay credit approval.

Company Name: City, State: Phone#: Fax#(required):

Contact: Account#:

Company Name: City, State: Phone#: Fax#(required):

Contact: Account#:

Open Account References Con’t…..

Company Name: City, State: Phone#: Fax#(required):

Contact: Account#:

Company Name: City, State: Phone#: Fax#(required):

Contact: Account#:

Bank Information:Name: Contact:

City/State: Type of Account:

Phone: Account Number:

ACCOUNT AGREEMENT AND TERMS OF SALEThe undersigned hereby applies to Hydro-Spray Wash Systems, Inc. for credit. It is understood and agreed that the undersigned specifically consents to Hydro-Spray Wash Systems, Inc. to investigate the applicant’s credit history for the purposes of extending credit. If credit is extended, I/We understand that Hydro-Spray Wash Systems, Inc’s credit terms are Net 15 Days from date of invoice unless specified. If payment is not made within 30 days Hydro-Spray Wash Systems, Inc. can then after 31 days charge the credit card on file for any unpaid past due invoices. Upon any change in principals or the legal identity of the company, the applicant will give written notice to Hydro-Spray Wash Systems credit department within 15 days. I/We certify that all of the above information is true and correct to the best of our knowledge. I/We further promise to pay reasonable attorney fees and any collection agency costs, whether or not a suit has been filed.

Date: By: __________________________________________________________ Signature (Officer or Principal Only)

Credit Card Information

Credit Card Type: _________________________________________________________________________________

Credit Card Number: ______________________________________________________________________________

Expiration Date: ___________________________________________________________________________________

Name as it appears on credit card: ____________________________________________________________________

Billing address for credit card: ________________________________________________________________________

_____________________________________________________________________________

For All Corporate ApplicationsI hereby guarantee with my personal and corporate assets the payment in full of all invoices due to Hydro-Spray Wash Systems, Inc.

Date:______________________ By:_____________________________________________(Must be signed by Controlling Officer)

Printed Name:_______________________________________________ SS#___________________________________________