HY-C Sales Partner Application

10950 Linpage Place St. Louis, MO 63132 PH: 314-241-1214 FX: 314-241-2277 www.hy-c.com

Section 2: Line of Credit Request

Requested Credit limit:

Requesting Credit line?  No (skip this page)  Yes (fill out this page)

Please provide references which meet the following criteria: • Applicant is currently doing business with or has done business within the last three (3) years. • Credit lines similar to the $ volume as requested with this application. • Do NOT submit references that applicant does NOT want HY-C to notify of Application for Account. • Accurate information will expedite the processing of your application . Please verify contact #’s & email addresses. Applicants may elect to contact the Supplier to encourage their response in a timely manner. Bank Reference Bank Name Name of Officer/Contact:

Street Address:

Email Address:

Mailing Address: (if different)

Phone #:

Fax #:

City, State

Postal Code

Account Type:

Account #:

Supplier Reference #1

Company Name

Name of Contact

Street Address:

Email Address:

Mailing Address: (if different)

Phone #:

Fax #:

City, State

Postal Code

Account #:

Supplier Reference #2

Company Name

Name of Contact

Street Address:

Email Address:

Mailing Address: (if different)

Phone #:

Fax #:

City, State

Postal Code

Account #:

Supplier Reference #3

Company Name

Name of Contact

Street Address:

Email Address:

Mailing Address: (if different)

Phone #:

Fax #:

City, State

Postal Code

Account #:

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