Nichols Lumber & Hardware Company 13470 Dalewood St., Baldwin Park, CA 91706 - (626) 960-4802 - FAX (626)962-1067 Print Out - Bank Release Form For the purpose of establishing credit accomodations, the following information is required:

Credit Manager, Nichols Lumber & Hardware Co. has request information for the purpose of extending us credit. Please furnish them with the information requested below at your earliest convenience. Please reply by fax to (626) 962-1067. Thank you, Signature:__________________________________   Company Name:_____________________________ Address:_________________________________   City:_________________   State:____   Zip:___________ Bank Account #:___________________________________________ For Bank Use Only Bank Account Information Account Opened:________________________________   Rating:__________________________________ Information completed by:____________________________________________   Date:_________________