CREDIT APPLICATION
Company: ____________________________ Years in Business: ________________
DBA:________________________________ Phone ( ) ________________________
Street: _______________________________ A/P Contact: _____________________
City: ______________________ State: _______________ Zip: __________________
Corp: ____ Partnership: _____ Proprietorship: _____ Principal: __________________

Do you release a financial statement? Yes______ NO____ Please attach if possible.

Listed with D&B? Yes ______ No ________ If yes DUNS#_______________

Bank Reference (1)                                  Bank Reference (2)
Name: __________________________   Name: _____________________________
Street: __________________________   Street: _____________________________
Acct #: _________________________     Acct #: _____________________________
Account Officer: __________________    Account Officer: ______________________
Phone: ( )______________________       Phone: ( ) ___________________________

Trade Reference (1)                                Trade Reference (2)
Name: __________________________ Name: _____________________________
Street: __________________________ Street: _____________________________
Acct #: _________________________   Acct #: _____________________________
Phone: ( )______________________      Phone: ( ) _________________________

Trade Reference (3)                               Trade Reference (4)
Name: __________________________ Name: _____________________________
Street: __________________________ Street: _____________________________
Acct #: _________________________   Acct #: _____________________________
Phone: ( )______________________     Phone: ( ) ___________________________
I hereby authorize the above listed bank and trade sources to release pertinent
information to Impress USA Inc
1. Signed: _____________________________
2. Title: _______________________________