Nichols Lumber & Hardware Company 13470 Dalewood St., Baldwin Park, CA 91706 - (626) 960-4802 - FAX (626)962-1067 Print Out - Credit Application - Page 1 of 2 For the purpose of establishing credit accomodations, the following information is required:

Billing Name:________________________________________   Phone:(________)___________________ Billing Address:__________________________________________   Fax:(________)___________________ City:____________________________   State:___________   Zip:______________   County:____________ Type of Business:__________________________________________________   Date started:____________ Contractors license #:_____________________________________   Resale #:________________________ Type of Ownership: __Individual     __Partnership     __Corporation         If Resale, please include Resale Card. Tax I.D. #:_________________________________________     If Corporation, in what state?_____________ Accounts Payable Contact:_______________________________   Phone:(________)___________________ List Principals, General Partners, or Owner as applicable:         1. Name:___________________________________________   Position:____________________________ Address:_________________________________   City:_________________   State:____   Zip:___________ Drivers License #:_________________________________   Social Security #:________-________-________ 2. Name:___________________________________________   Position:____________________________ Address:_________________________________   City:_________________   State:____   Zip:___________ Drivers License #:_________________________________   Social Security #:________-________-________ List Established Credit References:         1. Name:___________________________________________   Phone #:(________)___________________ Address:_________________________________   City:_________________   State:____   Zip:___________ 2. Name:___________________________________________   Phone #:(________)___________________ Address:_________________________________   City:_________________   State:____   Zip:___________ 3. Name:___________________________________________   Phone #:(________)___________________ Address:_________________________________   City:_________________   State:____   Zip:___________