300 N. Elizabeth St. Chicago, IL 60607 USA Tel: 312-226-2473 Fax: 312-226-2480 www.bird-x.com sales@bird-x.com

               NEW ACCOUNT CREDIT APPLICATION

NAME_______________________________________________________________________

ADDRESS____________________________________________________________________

CITY, STATE, ZIP_____________________________________________________________

PHONE(       )___________________________FAX (       )_____________________________

TYPE OF BUSINESS__RETAILER   __DISTRIBUTOR  __OTHER (describe__________)

TYPE OF PRODUCTS OF SERVICES____________________________________________

TAX ID#_________________________DATE ESTABLISHED/INCORPORATED_______

BANK_____________________________  ACCOUNT NUMBER______________________

ADDRESS___________________________   PHONE(      )____________________________

REFERENCES (Please provide 3 Trade references including phone numbers)

COMPANY                      CONTACT                   PHONE             ACCOUNT NUMBER

1.____________________________________________________________________________

2.____________________________________________________________________________

3.____________________________________________________________________________

We certify that all information on this form is correct.  We agree to promptly pay (Net Terms 30 Days).  In the event of

non-payment, the undersigned hereby agrees to pay in addition to the principal amount due, all collection charges, incurred

by seller, including charges made by a collection agent.  We also give permission to check with given references.

SIGNED____________________________________________________DATE____________

TITLE______________________________________________________

*please attach financials if available*   fax or mail to the attn: Sandra Richmond (credit)