ST. LOUIS HOME OFFICE 6801 HOFFMAN ST. LOUIS, MO 63139 PHONE (314) 645-5656 FAX (314) 645-9038

BRANCHES ARNOLD FENTON O'FALLON WEST COUNTY NORTH COUNTY CAPE GIRARDEAU

PLEASE FILL OUT FORM COMPLETELY THEN PRINT, SIGN, & MAIL TO ABOVE ADDRESS ATTN: ACCOUNTS RECEIVABLE

COMPANY NAME	DATE
ADDRESS	TELEPHONE#
CITY,STATE,ZIP	FAX# CELL#
OFFICER'S NAME	TITLE
OTHER OFFICER	TITLE
THE COMPANY IS A CORPORATION PROPRIETORSHIP PARTNERSHIP OTHER
IF THE COMPANY IS A CORPORATION, THE EXACT CORPORATE NAME IS
BANK NAME ACCOUNT NAME ACCOUNT NUMBER
PERSON DIRECTLY RESPONSIBLE FOR PAYMENT OF BILLS
PERSON(S) AUTHORIZED TO CHARGE TO ACCOUNT
HAVE YOU EVER DECLARED BANKRUPTCY? YES NO
HAVE YOU CURRENTLY RESTRICTED ON CREDIT FROM ANY OTHER COMPANY DUE TO NON-PAYMENT OF DEBT? YES NO
WHAT DO YOU ANTICIPATE YOUR MONTHLY CREDIT REQUIREMENTS TO BE? $

CREDIT REFERENCES:
NAME	NAME
ADDRESS	ADDRESS
TELEPHONE#	TELEPHONE#
NAME	NAME
ADDRESS	ADDRESS
TELEPHONE#	TELEPHONE#

ST. LOUIS METRO ELECTRIC SUPPLY, INC., TERMS OF PAYMENT FOR PURCHASES ON OPEN ACCOUNT ARE: 2% DISCOUNT ON ALL PURCHASES OF MATERIAL BY CUSTOMER, EXCEPT ON WHOLE HOUSE BUILDER ALLOWANCE(S) WHEN PAYMENT IS RECEIVED BY THE 10TH DAY OF THE MONTH FOLLOWING THE PURCHASE OF MATERIAL. NET PAYMENT OF THE GROSS AMOUNT IS DUE AFTER THE 10TH DAY AND BEFORE THE 30TH DAY OF THE MONTH FOLLOWING THE PURCHASE OF MATERIAL. THE INDIVIDUAL(S) WHOSE SIGNATURE(S) APPEAR BELOW HAVE AUTHORIZED ST. LOUIS METRO ELECTRIC SUPPLY, INC. TO OBTAIN CONSUMER CREDIT HISTORY, IF NEEDED, IN ORDER TO PROCESS THIS APPLICATION. APPLICANTS NEEDING CREDIT OF $5,000.00 OR MORE MAY BE REQUIRED TO SUBMIT ADDITIONAL CREDIT INFORMATION. THE CUSTOMER AGREES TO PAY WITHIN THE ABOVE TERMS OF PAYMENT. ANY AMOUNT OWED BY THE CUSTOMER PAST THE 30TH DAY FOLLOWING THE MONTH OF PURCHASE WILL BE CONSIDERED PAST DUE AND THE CUSTOMER AGREES TO PAY A SERVICE CHARGE OF 1-1/2% PER MONTH ON THIS PAST DUE AMOUNT. ANY ACCOUNTS WHO HAVE A PAST DUE BALANCE CAN BE PLACED ON CREDIT HOLD. THE INDIVIDUAL(S) WHOSE SIGNATURE(S) APPEAR BELOW ATTEST TO BEING PRINCIPAL(S) IN THE ABOVE NAMED APPLICATION, AND DO HEREBY AGREE TO BE RESPONSIBLE FOR ITS INDEBTEDNESS AND, IF APPROVED, PERSONALLY PROMISE(S) TO PAY ALL CHARGES ACCRUED FROM THE PURCHASE OF MATERIALS AND/OR SERVICES PROVIDED BY ST. LOUIS METRO ELECTRIC SUPPLY, INC., d.b.a. METRO ELECTRIC SUPPLY AND/OR METRO LIGHTING AND ALL SERVICE CHARGED ACCRUED FROM PAST DUE BALANCES AND ALL ATTORNEY FEES RESULTING FROM THE COLLECTION OF THESE CHARGES. THE SIGNING OF THIS DOCUMENT OBLIGATES THE INDIVIDUAL(S), WHETHER APPLYING PERSONALLY, CORPORATELY, AS A SOLE PROPRIETORSHIP, OR AS ANOTHER BUSINESS ENTITY. CREDIT CANNOT BE APPROVED UNLESS THIS GUARANTEE IS SIGNED.

SOME APPLICANTS MAY BE REQUIRED TO SIGN A GUARANTEE AND COLLATERALIZED PERSONAL PROMISSORY NOTE. THIS IS NOT A REFLECTION OF YOUR CREDIT WORTHINESS, BUT IS BASED ON THE APPLICANT'S LACK OF CREDIT HISTORY OR INFORMATION AND/OR INSUFFICIENT CREDIT REFERENCES.