You are applying for a credit line of $. Please provide a minimum of three credit references that have equal or greater credit lines, U.S. ones preferred.

Company Name	Contact	Telephone Number (very important)

In the fields provided below please include your bank information.

Name of Bank:
Account Number:	Checking     Savings
Contact:
Telephone Number (Very Important):
FAX Number (Very Important):
PURCHASE AGREEMENT

Amounts due on invoices from any and all purchases made by:
(CUSTOMER NAME):
from CHANNEL-TEK INT'L. CORP. will be paid under the following conditions and terms:

TERMS:
Payment on invoices due in full within 30 days from date of invoice unless otherwise agreed upon in writing.

LATE PAYMENT & C.O.D.:
Past due invoices are subject to late payment service charges of 1.5% per month. Accounts 60 days old will be placed on C.O.D. and legal action will be taken after an account is 90 days old.

RETURN GOODS:
Returned goods will not be accepted without a return authorization number and indication of the invoice number that applies.

HANDLING/RESTOCKING CHARGE:
A handling or restocking charge will be made on all goods returned unless due to error caused by supplier or otherwise agreed upon in writing.

TITLE:
Titles to any and all goods purchased shall remain with CHANNTEL-TEK INT'L. CORP. until the full purchase price has been paid.

LITIGATION:
In the event of any litigation arising out of this agreement CHANNEL-TEK INT'L. CORP. shall be entitled to its reasonable costs and expenses incurred including but not limited to attorneys fees.

CUSTOMER HEREBY AGREES TO THE FOREGOING AND REPRESENTS THAT ALL CREDIT INFORMATION GIVEN IS TRUE, COMPLETE AND CORRECT, BY COMPLETING THE FOLLOWING THREE FIELDS:

TYPE NAME:
TITLE:
DATE:

ORDER INFORMATION

Please complete the following fields to place an order: