High

Performance

Alloys, INC.

Distribution, Sales & Admin:

500N. 1985E.
Winfall, IN 46076

Phone: 1(765)945-8230
Toll-Free Phone: 1(800)HPALLOY(472-5569)
Fax: 1(765)945-8294
E-mail: service@hpalloy.com

  production:

444 Wilson Street
Tiptop, IN 46072

Credit Application

Company Name:

Bill to Address:

Bill to Address:

Bill to City:

State:

Zip:

Country:

Phone:

Accounts payable telephone:

Ship to Address:

Ship to Address:

Ship to City:

State:

Zip:

Country:

Fax:

Accounts payable e-mail:

Bank Name:

Telephone#:

Bank Acc#:

Bank Officer:

Credit References of metal distributors, heavy industrial companies (attach separate sheet if necessary)
Company Individual Phone# Fax#
1.
2.
3.
4.
Company Officers - * are required for credit approval.

President:*

Controller:*

General Manager:*

Federal I.D.#:*

Soc. Sec.# private Co:*

*Company type(please circle) Private, Incorporated, Limited?

Are you exempt from Indiana State Sales Tax?

Indiana State Exemption#:

Parent Company?*

Phone#:

In granting crerdit to you High Performance Alloys, Inc; it is hereby agreed that your terms of payment will be 1% 10 days, net 30 days. Payments are to be made on a U.S. bank with U.S. Dollers. Returned checks are subject to a $35 service fee. Overdue accounts will be charged an interest of 1.5% per month. Application agrees that venue and jurisdiction for any such court action shall properly be in Tipton Country, Indiana; the principal palce of business for Hign Performance Alloys, Inc. Deptor agrees that collection costs, attorney fees, and court costs will be paid by buyer/debtor.
  Applicant acknowledges receipt of and agrees hereafter to accept Hign Performance Aplloys, Inc. terms and conditions of open credit.
Applicant's signature indicates they are an authorized representative of debtor's firm. Applicant's signatureattests debtor' financial responsibility,a bility and willingness to pay H.P.A. invoices in accordance with the above terms.

Name:(Printed)

Signature:

Date:

Position:

Failure to sign this form will result in a review of your credit terms, and possible revocation of credit terms.
Visit HPAlloy.com for product
information, data sheets, and on-
line small quality ordering.
PRODUCTS and DISTRIBUTORS of
NICKLE-BASED, COBALT-BASED, and
SUPER STAINLESS ALLOYS
FM-74-15 Rev. B
Required Required Required Required Required