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                        APPLICATION FOR CREDIT                                           NOTE:  PLEASE TYPE OR PRINT.


               Complete Name of
               Your Business:

        Full Address:
                                                                     City                 State          Zip Code
        Telephone Number : (           )                                         Approx. Number of Employees:
        FAX Number:          (           )

        Check One:             Corporation         L.L.C.                Partnership           Personal
        Names of                                                         Title:
        Principals:                                                      Title:


        Building: Owned                Leased               Date Started
        Type of Business:
                                                  EXAMPLE: Injection Molders, Extruders, Blow Molders, Die Makers, Distributors, etc.
        Types of Equipment:
                                                      EXAMPLE: Injection Molding Machines, Extruders, Mills, Lathes, etc.
        Complete Name of Your Bank:
        Address:

        Accounts Payable Contact:
        Name:                                                       E-mail:
        Telephone Number : (           )                            FAX Number: (           )

        Please List Five Business References below:  (Please include phone and fax telephone numbers)


        Name                   Complete Address                          City                  State  Zip Code


        Phone/FAX Numbers                                                Your Account Number
        Name                   Complete Address                          City                  State  Zip Code


        Phone/FAX Numbers                                                Your Account Number
        Name                   Complete Address                          City                  State  Zip Code


        Phone/FAX Numbers                                                Your Account Number
        Name                   Complete Address                          City                  State  Zip Code


        Phone/FAX Numbers                                                Your Account Number
        Name                   Complete Address                          City                  State  Zip Code


        Phone/FAX Numbers                                                Your Account Number
        By:                                                              Date form completed:
            Signature
                                                                         The above information will provide us with a basis for granting credit. You have our
                                                                         assurance that all credit information is held in the strictest of confidence.
            Please Print Name
                         OUR PAYMENT TERMS ARE NET 30 DAYS

                                     © Copyright 2016 Plastic Process Equipment, Inc.
                PLASTIC PROCESS EQUIPMENT, INC.
                   8303 CORPORATE PARK DRIVE, MACEDONIA, OHIO 44056, USA
                     216-367-7000 • Fax: 216-367-7022 • Order Fax: 800-223-8305
                           Toll Free USA, Canada & Mexico: 800-362-0706
          PPE                      www.ppe.com • sales@ppe.com
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