PART 1 BUSINESS INFORMATION

Company NameTax I.D. #Yr. Established

Current Business Address City StateZip

Phone Fax E-mail

Years at Current Location Type of Business: Retail Contractor Other:

Are you tax exempt? Yes No , If so, please forward a copy of your Sales Tax Exemption form. # of Employees

Pres. Home Address

City State Zip Home Phone

V. Pres. Home Address

City State Zip Home Phone

Bank Reference Contact Person Phone

Do you require job names? Yes No , Purchase orders? Yes No , Do you want dray tickets priced? Yes No

If you want restrictions on who can charge, please list names: Name:

Name: Name: Name:

Any other requirements, which you need on your account?

PART 2 INDIVIDUAL or "PRINCIPAL’S" PERSONAL GUARANTEE

Please complete this personal guarantee for all individual credit applications. In the event the company or corporation has minimal business credit data available, it may be necessary to rely on the principal executive’s personal guarantee and credit report to secure your open credit line with Beyers Lumber Co. Please complete all the following information:

Last Name First Name Middle Initial Date of Birth

Current Address City State Zip Phone

SSN Drivers License #  

PART 3 CREDIT INFORMATION

Please list four business references with whom you have open credit account status:

Name of Co. Phone Fax Account #

Name of Co. Phone Fax Account #

Name of Co. Phone Fax Account #

Name of Co. Phone Fax Account #

IN COMPLIANCE WITH THE FAIR CREDIT REPORTING ACT, THIS IS TO INFORM YOU THAT YOU ARE AUTHORIZING THIS ORGANIZATION AND/OR ITS SUPPLIERS TO OBTAIN A CONSUMER AND/OR BUSINESS PROFILE CREDIT REPORT. YOU HAVE THE RIGHT TO DISPUTE THE INFORMATION ON THIS REPORT AND REQUEST ADDITIONAL DISCLOSURES PROVIDED UNDER SECTION 606§1681d(b) OF THE FAIR CREDIT REPORTING ACT, AND A WRITTEN SUMMARY OF YOUR RIGHTS PURSUANT TO SECTION 609(c). YOU MAY DO THIS BY CONTACTING THE PROVIDER OF THE INFORMATION. PLEASE CALL BACKGROUND INVESTIGATIONS, INC. PHONE 1 800 955-1356 AND YOU WILL BE DIRECTED TO THE PROPER CREDIT REPORTING AGENCY OR ASSISTED IN YOUR INQUIRY. THIS ORGANIZATION IS NOT ALLOWED TO GIVE YOU A COPY OF YOUR CREDIT REPORT. YOU ALSO RELEASE FROM LIABILITY ANY PERSONS INVOLVED IN THE CREDIT INVESTIGATION.

I/We certify, to the best of my/our knowledge, that all statements above are true and complete. I/We further authorize Beyers Lumber and its suppliers to obtain any and all information related to credit information and credit worthiness related to obtaining credit from Beyers Lumber. If this account requires submission to an attorney for collection, customer agrees to pay reasonable attorney fees. Terms: Balance is due on the tenth day of the month following the statement date. Accounts not paid by the last day of the month in which due are assessed a finance charge of 1-1/2 % per month (18% A.P.R.).