Avalon Advanced Products, Inc.
Credit Application

To: Accounts Receivable
Fax: 832-595-2235
Phone: 832-595-8565

Customer Acct #_________________
Name:_____________________________Phone:(      )________________Contact:____________________
Billing Address:_______________________________City:_____________State:_____Zip:______________
Ship to Address:______________________________City:_____________State:_____Zip:______________
County:___________________ TIN___________________ DUN's__________________________
Type of Facility: Distributor Dealer Rental Field Other: Specify_______________________

A/P Dept. Contact:___________________Phone:(      )_______________Fax:(      )__________________

Is account exempt from sales tax? Yes No (If Yes, a Tax Exemption Certificate must be enclosed)
How long have you been in business?_______ (If less than 1.5 years, a personal guarantee may be required)
Will a loan or leasing company fund your 1st purchase? Yes No
If yes, please provide name and number of contact:______________________________________________
Were you contacted by a sales representative: Yes No If yes: Name of representative____________________

Bank References
Bank:___________________________________________________________________________________
Address:____________________________________City:_____________State:______Zip:_______________
Banker Name:_______________________Phone:(      )________________  Fax(      )____________________

Trade/Supplier References:
Name:___________________Address:__________________Fax:____________Phone:______________
Name:___________________Address:__________________Fax:____________Phone:______________
Name:___________________Address:__________________Fax:____________Phone:______________

Terms: Credit terms are Net 30 days from invoice date. Outstanding balances are subjected to 1.5% interest per month.
The undersigned authorizes and releases all banks, persons, and companies listed on this application to furnish
information and authorizes the checking of credit. The undersigned agrees to pay all collection costs, court costs, and
legal fees incurred to ccollect delinquent balances. No terms or conditions different from those stated above will become
part of agreement of sale; the terms may not to be altered.

Please Sign Here:

Signed:__________________________________Printed Name __________________________________
Title:___________________________________________Date:__________________________________

Personal Guarantee (SIGN HERE IF LESS THAN 1.5 YEARS IN BUSINESS)
In consideration for credit extended, the undersigned contracts and guarantees to the faithful payment, when due, of all
accounts of the company seeking credit for 5 years from the date of this application. The undersigned guarantor expressly
waives all notice of acceptance of the guarantee, notice of extension of credit, presentment of demand for payment and any
notice of default by the company seeking credit and all other notices the guarantor might be entitled to. Revocation of the
guaranty shall be in writing and delivered by certified mail.

Print Name:____________________________SS#______________________Title_________________

Signature:_____________________________Date:_____________________ Phone(      )____________