Imtek Environmental Corporation-Online Credit Application

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ADDRESS

   Name:  
  Title:
Company:
Address:
   City:  
  State:  
    Zip:
Country:
  Phone:  
    FAX:
 E-mail:

_____________________________________________________________________

PRINCIPALS (if corporation, list officers, if partnership, list partners)

1.      Name 
       Title 
Home Address 
        City 
       State 
         Zip 
     Country 
       Phone 

_____________________________________________________________________

2.      Name 
       Title 
Home Address 
        City 
       State 
         Zip 
     Country 
       Phone 

_____________________________________________________________________

3.      Name 
       Title 
Home Address 
        City 
       State 
         Zip 
     Country 
       Phone 

_____________________________________________________________________

SALES TAX STATUS

Not Tax Exempt
Tax Exempt --- Exempt # 

_____________________________________________________________________

BANK REFERENCE

Bank Officer 
   Bank Name 
     Address 
        City 
       State 
         Zip 
     Country 
       Phone 
   Account # 

_____________________________________________________________________

TRADE REFERENCES

1. Contact Name 
        Company 
        Address 
           City 
          State 
            Zip 
        Country 
          Phone 

_____________________________________________________________________

2. Contact Name 
        Company 
        Address 
           City 
          State 
            Zip 
        Country 
          Phone 

_____________________________________________________________________

3. Contact Name 
        Company 
        Address 
           City 
          State 
            Zip 
        Country 
          Phone 

_____________________________________________________________________

BUSINESS INFORMATION

Individual
Partnership
Corporation

   Type of Business 
Number of Employees 
  Years in Business 
     Annual Sales $   

    D+B Listed?  Yes  No
Amount of Credit Requested $ 

_____________________________________________________________________

BY COMPLETING THIS APPLICATION FOR CREDIT, THE APPLICANT:

1. Attests financial responsibility, ability and willingness to pay all invoices
in accordance with the following terms: 2% 30; Net, 30 days, service charges will be
paid at the rate of 1.5% (18% annual rate) on all balances over 30 days.

2. Hereby Authorizes IMTEK ENVIRONMENTAL CORP. to investigate
the references listed pertaining to the applicant's credit and financial responsibility and
obtain additional information by securing data from a credit reporting agency.

3. Hereby Agrees that should it become necessary to assign the applicant's
account to a licensed collection agency or atttorney for legal action, all subsequent
collection charges and legal fees shall be paid by the applicant.

4. Hereby Authorizes the seller, its successors and assigns, by the seller's
designated attorney to waive the issuance of process and confess judgment against the
applicant for the entire unpaid balance of applicant's account together with all costs
applicable to such action.

5. Certifies and Warrants that the information given in this application is true and
correct and is given for the purpose of obtaining credit.

Applicant Name 
      Position 
          Date 


Applicant Name 
      Position 
          Date