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All information will be held in the strictest confidence (*=required field).



A/P CONTACT PERSON

OWNERSHIP

FINANCES

REFERENCES

I hereby authorize Campbell Scientific, Inc. (CSI), to verify any credit information provided by this source document. I further authorize our banks, trade references and financial institutions the right to release by telephone or fax all credit information requested by CSI. We understand that ANY information obtained by CSI will be held in confidence. The requested information will be used solely in assisting and securing credit terms for the applicant.

Credit privileges are hereby requested and it is understood and agreed that upon approval, the terms of payment are net within 30 days from the date of shipment. Delinquent accounts are subject to a finance fee of 11/2% (18% annually) late charge until order is paid in full. Buyer will also be charged reasonable attorney's fees should collection by suit be required.

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