Company Name:

Street Address: City: State: Zip:

Mailing Address: City: State: Zip:

Phone: Fax:

Federal I.D. # Resale/Tax Exempt #

References

Bank Name:

Address: City: State: Zip:

Phone: Fax: Account #:

Name of Your Banking Officer:

Types of Accounts Maintained:

Checking

Savings

Loans

Leasing

Trade References

1. Name & Address:

Phone: Fax: Contact Person:

2. Name & Address:

Phone: Fax: Contact Person:

3. Name & Address:

Phone: Fax: Contact Person:

I hereby certify that the aforementioned is true and correct, and I authorize the assignee of record, Power & Electric Company, 2950 E. Harcourt St., Rancho Dominguez, CA 90221, to conduct a credit investigation, to include a search for liens and to obtain all necessary information as required, Including Experian Reports.

By (Company name):

(Name of Officer or Authorized Employee and Title):

Date: