Date:
Firm Name:
Street Address:
City:	State: <Select> AK AR AZ CA CO CT DC DE FL GA HI ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY Zip:
Phone:	Fax:
Mailing Address (If Different)
City:	State: <Select> AK AR AZ CA CO CT DC DE FL GA HI ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY Zip:
Check One: Sole Proprietorship      Partnership       Corporation
If Incorporated Please Indicate Corporation Date:
How Long in Business:Years     Months
Social Security #:
Federal I.D. #:
Monthly Credit Requested:
President/ Vice-President:
City:	State: <Select> AK AR AZ CA CO CT DC DE FL GA HI ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY Zip:
Have you ever applied for credit with Woodland Specialties, Inc. before? Yes   No
If Yes Under What Name?
Will you furnish a financial statement?               Yes   No
Do you have any pending liens or judgements?   Yes   No
Are you exempt from sales tax?                        Yes   No

If yes, please provide a sales tax certificate signed by an officer of your corporation.
In applying for credit with Woodland Specialties, Inc. I understand and agree that credit terms are 2% 15 ADI net 30 unless otherwise noted on the invoice and all purchases are due within 30 days date of invoice. A 2% interest charge is applied after 30 days and unearned discounts as well as interest charges must be paid prior to discount being allowed on future purchases. Month end statements are rendered for your reconciliation purposes only. Please pay by invoice.

In consideration of Woodland Specialties, Inc., Its' subsidiaries or affiliates I/We jointly or severally do guarantee unconditionally at all times to Woodland Specialties, Inc., its' subsidiaries or affiliates, the payment of indebtedness or balance of the within named firm; including all collection costs, court costs, attorney's fees in the event that it is necessary to place the account for collection.

Date:

Signature of Officer:______________________________________________________________

Credit References:
1	Name:
	Phone:
	City:	State: <Select> AK AR AZ CA CO CT DC DE FL GA HI ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY Zip:
	Contact:
2	Name:
	Phone:
	City:	State: <Select> AK AR AZ CA CO CT DC DE FL GA HI ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY Zip:
	Contact:
3	Name:
	Phone:
	City:	State: <Select> AK AR AZ CA CO CT DC DE FL GA HI ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WV WY Zip:
	Contact: