COMPANY NAME: ____________________________________________________
SHIPPING ADDRESS: __________________________________________________
2nd SHIP ADD. LINE: ___________________________________________________
CITY: ______________________________ STATE: ________ ZIP CODE:__________
PHONE NUMBER:_(____)___________ EXT.: _____
FAX NUMBER:_(____)_____________
E-MAIL ADDRESS: _____________________________
YEAR BUSINESS WAS ESTABLISHED: (must have)________________________


BILLING NAME and ADDRESS IF DIFFERENT THAN ABOVE: (You may omit any
information in the billing section below which is duplicated in the above
shipping section.)

COMPANY NAME: ____________________________________________________
BILLING ADDRESS: ___________________________________________________
2nd BILL ADD. LINE: __________________________________________________
CITY: ______________________________ STATE: ________ ZIP CODE:__________
PHONE NUMBER:_(____)___________ EXT.: _____
FAX NUMBER:_(____)_____________
E-MAIL ADDRESS: _____________________________
Into what business category would your organization fit?

OEM (Original Equipment Manufacturer)_____ DISTRIBUTOR **_____
MRO (Maintenance or Repair Operation) _____ END USER _____
GOVERNMENT AGENCY _____
**If you selected 'DISTRIBUTOR' above, then check the
appropriate product groups below.


FASTENERS:_____ HAND TOOLS:____ CUTTING TOOLS:____
MEASURING TOOLS:____ HYDRAULICS/PNEUMATICS:_____
METAL SHAPES:_____ OIL SEALS/O-RINGS:_____ GENERAL LINE:_____
MECHANICAL POWER TRANSMISSION EQUIPMENT:____ BEARINGS:_____
ELECTRICAL/ELECTRONIC:_____ PLUMBING SUPPLIES:_____
--------------------------------------------------------------------------
REFERENCES: (must have had activity within 1 year.)
BANK NAME:_______________________ ACCOUNT # (must have)________________
ADDRESS: ______________________________________________________________
CITY: ______________________________ STATE: ________ ZIP CODE:___________
PHONE NUMBER:_(____)__________ EXT.: _____
FAX NUMBER:_(____)____________
E-MAIL ADDRESS: _____________________________

REFERENCE No. 1 COMPANY NAME:______________________________________________
ADDRESS: ______________________________________________________________
CITY: ______________________________ STATE: ________ ZIP CODE:__________
PHONE NUMBER:_(____)___________ EXT.: _____
FAX NUMBER:_(____)_____________

REFERENCE No. 2 COMPANY NAME:______________________________________________
ADDRESS: _______________________________________________________________
CITY: ______________________________ STATE: ________ ZIP CODE:__________
PHONE NUMBER:_(____)___________ EXT.: _____
FAX NUMBER:_(____)____________

I hereby authorize Maryland Metrics to request credit information from the
above listed banks and trade credit references.

SIGNATURE:________________________ TITLE :________________ DATE:___________

You may fold this form so that the mailing address below fits a #10 window envelope.

Maryland Metrics (credit dept.)

P.O.Box 261

Owings Mills, MD 21117-0261 USA