REFERENCES-(LIST PRINCIPAL SUPPLIERS, PREFERABLY ELECTRICAL) NAME EMAIL .ON ENOHPELET ACCOUNT NO

ADDRESS CITY ST ZIP CODE

NAME EMAIL .ON ENOHPELET ACCOUNT NO

ADDRESS CITY ST ZIP CODE

CONTINUE TO PAGE 2

DATE OF APPLICATION SALESPERSON BRANCH NO. EST. MONTHLY PURCHASES CREDIT LINE REQUESTED

LEGAL BUSINESS NAME FEDERAL TAX IDENTIFICATION/SOCIAL SECURITY NO.

TRADE NAME OF BUSINESS (IF DIFFERENT)

BILLING ADDRESS (STREET ADDRESS REQUIRED) CITY ST ZIP CODE

SHIPPING ADDRESS (IF DIFFERENT THAN BILLING ADDRESS) CITY ST ZIPCODE

PURCHASING CONTACT TELEPHONE NUMBER )TNIRP ESAELP( TCATNOC GNISAHCRUP

PURCHASING CONTACT EMAIL ADDRESS

ACCOUNTING CONTACT TELEPHONE NUMBER )TNIRP ESAELP( TCATNOC GNITNUOCCA

ACCOUNTING CONTACT EMAIL ADDRESS

PRIMARY EMAIL ADDRESS FOR INVOICE DELIVERY:

WOULD YOU LIKE TO SET-UP A “MY COLONIAL” ONLINE ACCESS ACCOUNT? YES NO

TYPE OF BUSINESS

INDUSTRIAL CONTRACTOR RETAIL MECHANICAL CONTRACTOR GENERAL CONTRACTOR COMMERCIAL CONTRACTOR PROP. MGMNT, OR

INSTITUTION, OR GOV’T RESIDENTIAL CONTRACTOR, BUILDER

OR ELECTRICIAN UTILITY INTERIOR DESIGNER OR DECORATOR

INDUSTRIAL/MRO DATACOM KITCHEN & BATH

ARCHITECT/ENGINEER OEM LANDSCAPER

NAME OF PARENT COMPANY AND DIVISIONS (IF APPLICABLE)

TAX EXEMPT YES NO (IF YES, ATTACH TAX EXEMPTION CERTIFICATE)

PURCHASE ORDER REQUIRED YES NO

HOW DID YOU LEARN ABOUT COLONIAL______________________ ______________________________________________________________

DO YOU WANT LITERATURE/MAILINGS SENT TO YOU PERIODICALLY? YES NO

WHICH OF OUR LOCATIONS DO YOU FREQUENT MOST? COLONIAL ELECTRIC BRIGHT LIGHT ANNAPOLIS LIGHTING COLONIAL TELTEK COLONIAL SOLUTIONS

COLONIAL MAJOR PROJECTS

C O N F I D E N T I A L C R E D I T A P P L I C A T I O N

WHICH IS YOUR PREFERRED BRANCH LOCATION? (Please select one)

KING OF PRUSSIA, PA

ALLENTOWN, PA

CENTER CITY PHILADELPHIA

COLLEGEVILLE, PA

DOWNINGTOWN, PA

GLENOLDEN, PA

LANCASTER, PA

MYERSTOWN, PA

NORTHEAST PHILADELPHIA

READING, PA

WARMINSTER, PA

WILMINGTON, DE

CAPE MAY COURT HOUSE, NJ

HAMMONTON, NJ

PLEASANTVILLE, NJ

VINELAND, NJ

BRONX, NY

BOWIE, MD

KING OF PRUSSIA, PA

BRONX, NY

BOWIE, MD

COLONIAL ELECTRIC BRANCHES COLONIAL ELECTRIC TELTEK

KING OF PRUSSIA, PA

ALLENTOWN, PA

NEWARK, NJ

CAPE MAY COURT HOUSE, NJ

BRIGHT LIGHT DESIGN CENTER

ANNAPOLIS LIGHTING

ANNAPOLIS, MD

BOWIE, MD

PISCATAWAY TOWNSHIP, NJ

COLONIAL ELECTRIC SOLUTIONS

KING OF PRUSSIA, PA

COLONIAL MAJOR PROJECTS

SECONDARY EMAIL ADDRESS FOR INVOICE DELIVERY:

BANK REFERENCES EMAIL .ON ENOHPELET EMAN KNAB ACCOUNT NO.

ADDRESS CITY ST ZIP CODE

EMAIL .ON ENOHPELET EMAN KNAB ACCOUNT NO.

ADDRESS CITY ST ZIP CODE

TYPE OF ENTITY

PROPRIETORSHIP PARTNERSHIP DATE ESTABLISHED

CORPORATION LLC OTHER STATE OF INCORPORATION DATE OF INCORPORATION

Have any lawsuits been filed against applicant within the last three years for non-payment debt? Yes No Has applicant including any of its owners, partners, or officers ever filed a voluntary petition in bankruptcy? Yes No

Have you been denied credit within the last 24 months? Yes No IF YES TO ANY QUESTION ABOVE, PROVIDE PARTICULARS: FILING/DENIAL DATE:

PARTNERSHIP OR PROPRIETORSHIP / LIMITED LIABILITY COMPANYPARTNER OR PROPRIETOR/MEMBER NAME #1 REBMUN ENOHPELET # YTIRUCES LAICOS

HOME ADDRESS-PO BOX/STREET ADDRESS CITY ST ZIP CODE

EMAIL ADDRESS

PARTNER OR PROPRIETOR/MEMBER NAME #2 REBMUN ENOHPELET # YTIRUCES LAICOS

HOME ADDRESS-PO BOX/STREET ADDRESS CITY ST ZIP CODE

EMAIL ADDRESS

CORPORATION FULL CORPORATE NAME:

PRESIDENT NAME TELEPHONE NUMBER

HOME ADDRESS-PO BOX/STREET ADDRESS CITY ST ZIP CODE

EMAIL ADDRESS

*PLEASE ATTACH ANY ADDITIONAL OFFICER OR COMPANY INFORMATION TO THIS APPLICATION

TERMS AND CONDITIONS OF QUOTES AND SALES ALL SALES ARE SUBJECT TO COLONIAL’S STANDARD TERMS AND CONDITIONS OF SALE IN EFFECT AS OF THE DATE OF THE PLACEMENT OF AN ORDER. COLONIAL OBJECTS TO ANY PROPOSED TERM THAT IS INCONSISTENT WITH ITS STANDARD TERMS OF SALE. COLONIAL’S CURRENT STANDARD TERMS AND CONDITIONS OF SALE CAN BE FOUND AT HTTP://WWW.COLONIALELECTRIC.COM/TERMSOFSALE AND QUOTE AT HTTP://WWW.COLONIALELECTRIC.COM/QUOTETERMS OR A COPY CAN BE OBTAINED FROM COLONIAL’S CUSTOMER FINANCIAL SERVICES DEPARTMENT. ALL TERMS AND CONDITIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------- APPLICANT CERTIFIES THAT ALL INFORMATION ON THIS APPLICATION IS CORRECT, AND THAT APPLICANT FULLY UNDERSTANDS THE CREDIT TERMS AND CONDITIONS OF COLONIAL ELECTRIC SUPPLY COMPANY, INC. (“COLONIAL”) AND AGREES TO THE PROPER PAYMENT IN CONSIDERATION OF EXTENDED CREDIT. APPLICANT HEREBY AUTHORIZES COLONIAL TO INVESTIGATE THE REFERENCES LISTED HEREIN, PERTAINING TO THE APPLICANTS CREDIT AND FINANCIAL RESPONSIBILITY.

¤NAME (PLEASE PRINT) AUTHORIZED SIGNATURE DATE

TITLE COMPANY

GUARANTY AND SURETYSHIP AGREEMENT IN CONSIDERATION OF COLONIAL EXTENDING CREDIT TO APPLICANT AND FOR OTHER GOOD AND VALUABLE CONSIDERATION, THE RECEIPT AND SUFFICIENCY OF WHICH IS HEREBY ACKNOWLEDGED, , __________________________________________________ (“GUARANTOR”) HEREBY UNCONDITIONALLY GUARANTEES AND BECOMES SURETY FOR THE FULL AND TIMELY PERFORMANCE BY APPLICANT OF ITS OBLIGATIONS PURSUANT TO ATTACHED CREDIT APPLICATION AND HEREBY AGREES AS FOLLOWS: 1. GUARANTOR AGREES TO GUARANTEE AND INDEMNIFY COLONIAL FOR ANY AND ALL DEBTS OF APPLICANT AND APPLICANT’ S SUCCESSORS AND ASSIGNS. IT IS UNDERSTOOD THATSUCH GUARANTY AND INDEMNIFICATION SHALL BE A CONTINUING AND IRREVOCABLE GUARANTY AND INDEMNITY FOR SUCH INDEBTEDNESS OF APPLICANT. 2. THIS AGREEMENT SHALL BE EFFECTIVE UNTIL EXPRESSLY REVOKED BY GUARANTOR BY THIRTY DAYS’ WRITTEN NOTICE TO COLONIAL. ANY SUCH REVOCATION SHALL NOT AFFECT GUARANTOR’ S LIABILITY TO COLONIAL AS TO GUARANTOR’ S INDEBTEDNESS CONTRACTED PRIOR THERETO. GUARANTOR HEREBY WAIVES NOTICE OF DEFAULT, NON-PAYMENT AND NOTICE THEREOF AND CONSENTS TO ANY MODIFICATION, WAIVER, RELEASE OR RENEWAL OF OR UNDER THE CREDIT AGREEMENT HEREBY GRANTED. GUARANTOR REPRESENTS AND AGREES THAT GUARANTOR HAS READ THE TERMS AND CONDITIONS OF THE CREDIT APPLICATION AND AGREES TO BE BOUND BY SAID TERMS AND CONDITIONS ASOF EVEN DATE THEREOF. 3. THE UNDERSIGNED HEREBY EMPOWERS ANY ATTORNEY OF ANY COURT OF RECORD WITHIN THE UNITED STATES OF AMERICA OR ELSEWHERE TO APPEAR FOR THE UNDERSIGNED AT ANY TIME AND, WITH OR WITHOUT COMPLAINT FILED, CONFESS JUDGMENT AGAINST THE UNDERSIGNED IN FAVOR OF ANY HOLDER HEREOF, AS OF ANY TERM, FOR THE UNPAID BALANCE OF THE OBLIGATIONS TOGETHER WITH UNPAID INTEREST THEREON, COSTS OF SUIT AND ATTORNEY'S COMMISSION FOR COLLECTION OF TWENTY-FIVE PERCENT (25%) OF THE TOTAL INDEBTEDNESS ON WHICH JUDGMENT ONE OR MORE EXECUTIONS MAY ISSUE FORTHWITH. THE UNDERSIGNED HEREBY FOREVER WAIVES AND RELEASES ALL ERRORS INSAID PROCEEDINGS, WAIVES STAY OF EXECUTION, AND WAIVES ALL EXEMPTIONS FROM LEVY AND SALE OF ANY PROPERTY THAT NOW ARE OR HEREAFTER MAY BE APPLICABLE. NO SINGLE EXERCISE OF THE FOREGOING POWER TO CONFESS JUDGMENT SHALL BE DEEMED TO EXHAUST THE POWER, WHETHER OR NOT ANY SUCH EXERCISE SHALL BE HELD BY ANY COURT TO BE VALID, VOIDABLE OR VOID, BUT THE POWER SHALL CONTINUE UNDIMINISHED AND IT MAY BE EXERCISED FROM TIME TO TIME AS OFTEN AS THE HOLDER HEREOFSHALL ELECT UNTIL SUCH TIME AS THE HOLDER SHALL HAVE RECEIVED PAYMENT IN FULL OF THE DEBT, INTEREST, ATTORNEY'S COMMISSION AND COSTS. INTEREST ON THE OBLIGATION EVIDENCED HEREBY SHALL CONTINUE TO ACCRUE AT THE ABOVE-STATED RATE AFTER THE ENTRY OF JUDGMENT HEREON. THE UNDERSIGNED HEREBY WAIVES ITS RIGHTS TO NOTICE AND A HEARING CONCERNING THE VALIDITY OF THE HOLDER'S CLAIMS HEREUNDER AND AGREES AND CONSENTS TO JUDGMENT BEING ENTERED BY CONFESSION IN ACCORDANCE WITH THE TERMS HEREOF AND EXECUTION BEING LEVIED ON SUCH JUDGMENT AGAINST ANY AND ALL PROPERTY OF THE UNDERSIGNED, IN EACH CASE WITHOUT FIRST BEING GIVEN NOTICE AND THE OPPORTUNITY TO BE HEARD ON THE VALIDITY OF THE CLAIM OR CLAIMS UPON WHICH SUCH JUDGMENT IS ENTERED.

¤GUARANTOR NAME (PLEASE PRINT) CO-GUARANTOR (PLEASE PRINT)

SIGNATURE DATE SIGNATURE DATE

Please return credit application to Attn: Customer Financial Services Dept. 201 W. Church Road, King of Prussia, PA 19406 or fax to 610-312-8130 or email it to accountsreceivable@colonialelectric.com