6350 East Rogers Circle Boca Raton, Florida 33487

PLUSCO SUPPLY CORP. 6350 East Rogers Circle Boca Raton, Florida 33487 Tel: (561) 241-9666  Fax: (561) 997-5499 FL Toll Free: 1-800-523-9373  USA Toll Free: 1-800-628-1980 Internet -- http://www.plusco.com  E-mail -- [email protected]

APPLICATION FOR CREDIT

Date: ______

Name of Business: ______

Business Address: ______

City, State, Zip: ______

Phone & FAX: ______

Name(s) of Authorized Buyer(s): ______

Do you require Purchase Order Numbers?  Yes  No

Check One:  Corporation  Partnership  Proprietorship

Owners and/or Partners: Name Address Phone Social Security Number

1. ______

2. ______

3. ______

Is there a management company?  Yes  No

If yes, please name: ______

Who should we contact regarding accounts payable?

Contact Name: ______

Telephone Number: ______

Will you furnish a financial statement?  Yes  No (If yes, please attach copy)

Have you ever filed bankruptcy or Chapter 11 Reorganization?  Yes  No || If yes, when:

How long has the business been in operation? ______

Bank: ______

Address: ______

Phone Number: ______

Type of Accounts:  Checking  Payroll  Commercial Loans  Savings

Account Numbers: ______

TRADE REFERENCES (list four major non-food related suppliers): Name Address Phone Fax

1. ______

2. ______

3. ______

4. ______

TAX STATUS:  Taxable  Non-Taxable

If Non-Taxable, provide exemption number: ______NOTE: If your purchases are tax exempt, we are required by law to obtain from you a signed Tax Exemption Certificate before we can omit sales tax from your billing.

TERMS: The undersigned understands and accepts the terms of payment on which PLUSCO SUPPLY CORP. grants credit, which are attached to this credit application.

AUTHORIZATION FOR CREDIT INVESTIGATION: The undersigned authorizes a credit investigation and authorizes those listed in this application to answer questions regarding their credit history.

INDIVIDUAL GUARANTEE OF PAYMENT: The undersigned, hereby being the principal(s) of the above business applicant, in consideration of PLUSCO SUPPLY CORP. extending credit to the applicant based upon this application, jointly and severally, individually, unconditionally guarantee(s) payment of any and all, present or future obligations and indebtedness which the applicant has incurred or shall incur to the above-named company. The undersigned agrees to pay for all goods and merchandise supplied by PLUSCO SUPPLY CORP. under the terms of stated above. In the event that it becomes necessary to retain an attorney in order to collect any outstanding amounts, the undersigned agrees to pay for all costs of collections, including but not limited to reasonable attorney's fees. Applicant hereby waives its privilege of being sued in its county and state of residence and agrees to submit to the jurisdiction of Palm Beach county, Florida.

The applicant agrees to immediately notify PLUSCO SUPPLY CORP. in writing at the above address of any change in ownership, form, address, or insolvency proceedings regarding the applicant business.

Signature of Applicant: ______

Printed or Typed Name of Applicant: ______

Title of Applicant and Social Security Number: ______

Date: ______