QUALITY CABLE & ELECTRONICS, INC.

CREDIT APPLICATION

COMPANY NAME: ___________________________________________________________________

ADDRESS: _________________________________________________________________________

CITY ____________________________________________ STATE: ____________ ZIP: ___________

PHONE: _____________________________________     FAX: ________________________________

CREDIT LIMIT REQUESTED - $___________________

IN BUSINESS SINCE? MONTH: _______ YEAR: _____

DUN & BRAD STREET RATED?  Y_______ / N_______     RATING: ____________________________

HAS THIS BUSINESS OR ANY MAJORITY OWNER DEFAULTED ON ANY LOANS, DECLARED CHAPTER 11, OR BANKRUPTCY?  Y_____ / N_______

(IF YES PLEASE ATTACH A SEPARATE SHEET OF PAPER WITH FULL EXPLANATION)

BANK REFERENCES

PRIMARY BANK: ____________________________________________________________________

ADDRESS: _________________________________________________________________________

CITY: __________________________________ STATE: _______________ ZIP: _________________

PHONE: ________________________________      FAX: ____________________________________

ACCOUNTT#: _____________________________ AVERAGE MONTHLY BALANCE: $__)__________

CONTACT: _________________________________________________________________________

SECOND BANK (IF APPLICABLE):  NAME: _______________________________________________

CITY: __________________________________ STATE: _______________ ZIP: _________________

PHONE: __________________________________  FAX: ____________________________________

CONTACT: ________________________________ ACCOUNT#: _____________________________

TRADE REFERENCES (WITHIN THE COMMUNICATION INDUSTRY)

1) COMPANY NAME: _________________________________________________________________

     ADDRESS: _______________________________________________________________________

     PHONE: ________________________________  FAX: ____________________________________

     CONTACT: _______________________________________________________________________

2) COMPANY NAME: _________________________________________________________________

     ADDRESS: _______________________________________________________________________

     PHONE: ________________________________  FAX: ____________________________________

     CONTACT: _______________________________________________________________________

3) COMPANY NAME: _________________________________________________________________

     ADDRESS: _______________________________________________________________________

     PHONE: ________________________________  FAX: ____________________________________

     CONTACT: _______________________________________________________________________

NAME OF OFFICER (PRINT): __________________________________    DATE: _________________

SIGNATURE: _______________________________________________________________________

(HARD COPY NEEDED (NOT FAX) FOR FINAL APPROVAL)

*INTERNATIONAL CLIENTS PLEASE FAX REQUEST FOR A SPECIAL APPLICATION*