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 3: Principals/Officers Responsible for Commercial Transactions

Owner/Shareholder #1

Name

Title:

Social Sec. #:

% of Ownership

Street Address:

City, State

Postal Code

In consideration of HY-C Company LLC extending credit, I/we jointly and severally do personally guarantee unconditionally to HY-C Company LLC the payment of indebtedness of the within named firm

Signature: _________________________________________________________________________ Date: _____________

Owner/Shareholder #2

Name

Title:

Social Sec. #:

% of Ownership

Street Address:

City, State

Postal Code

In consideration of HY-C Company LLC extending credit, I/we jointly and severally do personally guarantee unconditionally to HY-C Company LLC the payment of indebtedness of the within named firm

Signature: _________________________________________________________________________ Date: _____________

Owner/Shareholder #3

Name

Title:

Social Sec. #:

% of Ownership

Street Address:

City, State

Postal Code

In consideration of HY-C Company LLC extending credit, I/we jointly and severally do personally guarantee unconditionally to HY-C Company LLC the payment of indebtedness of the within named firm

Signature: _________________________________________________________________________ Date: _____________

Please duplicate page if there are more than three (3) Owner/Shareholders

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