D.B.F. COLLECTION CORP. - SAMPLE OPEN ACCOUNT CREDIT APPLICATION

DATE ___________________     ALL QUESTIONS MUST BE ANSWERED

ACCOUNT NAME: _____________________________________________

INDIVIDUAL ___ PARTNERSHIP ___ CORPORATION ___ OTHER ___
If a Corporation, officers must personally guarantee payment
of account in space provided below

Business Address: _________________________________________________
						 Is Written P.O.
Telephone #: ______________________ Required ?  ____________
									How Long In 
Type of Business: __________________________ Business? _____

Have you or business ever had an account with us Before ?_____
If so, Provide details _____________________________________

TRADE REFERENCES:
NAME                   COMPLETE ADDRESS              PHONE #

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

BANK REFERENCE:
NAME OF BANK: ______________________ PHONE # ______________________

ACCOUNT TYPE _______________ ACCOUNT #________________________

ADDRESS OF BRANCH _________________________________________________

LIST NAME(S) ADDRESSES AND TELEPHONE NUMBERS OF OFFICERS OF
YOUR COMPANY ______________________________________________________

_____________________________________________________________________

I (WE) HEREBY INDIVIDUALLY AND JOINTLY GUARANTEE PAYMENT OF THIS ACCOUNT. THIS GUARANTEE CAN NOT BE CANCELED ORALLY. WE AGREE THAT IN THE EVENT OF NON-PAYMENT OF THIS ACCOUNT, WE WILL BE HELD LIABLE FOR A 25% FEE FOR COLLECTION OR LITIGATION, TOGETHER WITH 1+1/2% INTEREST PER MONTH. 

________________________________ 	 ____________________________
Signature of Guarantor			 	Signature of Guarantor

Print name :____________________ 	 ____________________________

S.S. # _______-______-____________  S.S. # _______-______-____________