MegaChem, Inc.
P.O. Box 1916  High Point, North Carolina 27261
Phone: 336-454-0100   Fax: 336-454-0204
 Credit Application: Complete & Fax   


    1.  Correct Name of Business: ________________________________________________
                                                     (enclose copy of letterhead if available)

          Telephone Number: (____)___________________Bookkeeper____________________

    2.   Bill To Address:  _________________________________________________
                                   
                                   _________________________________________________
    
    3.  Ship To Address: _________________________________________________

                                   _________________________________________________
    4.  Names and Title of Principals:

                 _______________________            ___________________________

                 _______________________            ___________________________
    5.  In Business Since _________        Same Location ______________________
                                      (Year)
    6.  Bank: ________________________________________________________
                               (Name and Complete Address - Specify if Branch)

         Telephone Number: ______________________  Contact: ______________________
    7.  Names and Complete Addresses of Principal Suppliers:

    1.  _______________   _________________________  _____________________
                (Name)                          (Street Address)                      (City, State, Zip)

         _______________   _________________________ _____________________
                 (Phone)                               (Fax)                                  (Contact)                       

    2.  _______________   _________________________  _____________________    
                (Name)                          (Street Address)                      (City, State, Zip)   

         _______________   _________________________  _____________________
                 (Phone)                              (Fax)                                  (Contact)       

    3.  _______________  _________________________  _____________________
                (Name)                         (Street Address)                       (City, State, Zip)

         _________________  ____________________________  ________________________
                (Phone)                               (Fax)                                   (Contact)

         Date: _______________               Salesman: __________________
                                                           
         Tax ID No. ____________________