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COMMERCIAL OPEN ACCOUNT CREDIT APPLICATION

1. Please review our terms and Conditions of sale.
2. Enter all appropriate information requested. (Kindly type the information with this window open.)
3. Print, sign and date this application and mail to us at the address below. (Please include credit references on a separate sheet.)

Fortune 1000 companies simply fax us your credit request and standard credit information sheet. Our fax number is (603) 724-6740

To expedite initial orders we accept Master Card, Visa, and Discover cards. You may also pay with American Express and electronic check using our Paypal gateway (You will not need to have and account with Paypal. Email us for details.)

Business and Billing Information     Full Legal Business Name:     Doing Business As or Also Known As:     Business Phone Number: ( ) -     Business Fax Number: ( ) -     Address (cannot be a P.O. Box):     City:     State: ... Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York State North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington State West Virginia Wisconsin Wyoming          ZIP:     Purchasing Contact Name:     Purchasing Contact Title:     Purchasing Contact Email Address:     Billing Address:     City:     State: ... Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York State North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington State West Virginia Wisconsin Wyoming     ZIP:     Billing Phone Number: ( ) -     Billing Fax Number: ( ) -     Billing Contact Name:     Billing Contact Title:     Business Structure: ... Parent Company Branch/Division/Subsidiary Single Location Business/Organization     Company Annual Revenue: ... non-profit $1 million or less more than $1 million     Non-Profit?: ... Yes No     Non-Profit Budget:     Non-Profit Source of Funding Information:     No. of Employees: ... 1-4 5-9 10-14 15-24 25-49 50-99 100-499 500+     Legal Structure: ... Corporation Sub S Corporation Limited Liability Corporation Professional Corporation Partnership Limited Liability Partnership Public School Private School Federal Government State Government County Government City Government     Proprietorship?: ... Yes No     Franchisee?: ... Yes No     Taxpayer ID Number:     Dun and Bradstreet Number (If available):     In Business Since:     Number of Locations:     P.O. Required?: ... Yes No     Anticipated Monthly Purchase Volume $: Bank Information     Bank Name:     Account Manager Name:     City:     State: ... Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York State North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington State West Virginia Wisconsin Wyoming     Bank Fax Number: ( ) -     Checking Account #: Parent Information (If you are a branch/division/subsidiary)     Parent Company Name:     Parent Company Address:     City:     State: ... Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York State North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington State West Virginia Wisconsin Wyoming     ZIP:

I hereby certify that the information contained herein is complete and acurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institution/s and credit references listed in this credit application to release necessary information to ATP in order to verify the information contained herein or to help establish credit. I have read, understand and agree to ADVANCED THERMOELECTRIC's terms and Conditions of sale.

Authorized Signature: ______________________________ Title: ____________________

Date: ____________________

Thank you!

Credit/Accounting
PO Box 7091
Nashua, NH 03060

Telephone (603) 888-2467
Fax (603) 724-6740
support@electracool.com