New Account Customer Form - uri=spal-usa

1731 SE Oralabor Road, Ankey IA, 50021Tel # 800-345-0327 Website: www.spalusa.com E-Mail: info@spalusa.com Fax # 800-654-7725Return To: SPAL SalesType Of Account Applying For: (check one)Net 30 Days __COD __Credit Card __As a SPAL customer, please be aware that all invoices relating to open accounts are sentvia e-mail to accounts payable contact. If you do not have e-mail we can send it via fax.We do not mail invoices.*****To expedite the approval process, *****Please print clearly and fill out all pages completely.Company Name:Address:City:State:Zip:Phone:Fax:Web Site:Accts Payable Contact: Phone: Fax:Accts Payable E-mail:Buyer Contact: Phone: Fax:Company InformationDate Business Established:Type of Business:State Tax ID #: Federal Tax ID #:Credit Line Requested:Product Most Interested In (Check One)Fans/Blowers __Accessories __Parent Company:Address:City:State:Zip:Phone:Fax:E-Mail:Web Site:Additional Ship-To Address:Address:City:State:Zip:Phone:Fax:E-Mail:Web Site:Page 1 of 3

1731 SE Oralabor Road, Ankey IA, 50021Tel # 800-345-0327 Website: www.spalusa.com E-Mail: info@spalusa.com Fax # 800-654-7725Bank Reference 1Bank Name:Account:Contact Person:Address:City:State:Phone:E-mail:Vendor ReferencesZip:Fax:Web Site:Fill in this information only if apply for Net 30 Account.*******All Four References Must Be Filled Out – Including Fax Numbers**************References Will Not Be Used Without a Fax Number**************References Are Required For All Open Accounts*******1. Company Name:Address:City:State:Phone:E-Mail:Zip:Fax:Web Site2. Company Name:Address:City:State:Phone:E-Mail:3. Company Name:Address:City:State:Phone:E-Mail:4. Company Name:Address:City:State:Phone:E-Mail:Zip:Fax:Web SiteZip:Fax:Web SiteZip:Fax:Web SitePage 2 of 3

1731 SE Oralabor Road, Ankey IA, 50021Tel # 800-345-0327 Website: www.spalusa.com E-Mail: info@spalusa.com Fax # 800-654-7725Dear Valued Client:Our company uses e-mail, fax, and telephone communications to keep you informed on a timelyand efficient basis of the products, services and opportunities we provide. In addition, orderconfirmations, shipping notices and invoices are sent to you via e-mail and fax. Recentamendments to FCC Regulations require that we have on file written consent to continue toprovide you information in these formats.Please complete this form and send back to us via mail or fax with your new customerinformation. If you have any question regarding this, please do not hesitate to contact our officeand speak with our sales associates at 800-345-0327. You may duplicate this form as required toinclude all corresponding contacts at your company. Thank you for your prompt attention.FACSIMILE CONSENT FORMI, ___________________________________ , agree this ___ day of ____________________ ,2007, to receive notices, advertisements, announcements, brochures and other information fromSPAL-USA via facsimile from (515) 289-7004, (402) 932-7947, (402) 505-4693, (909) 926-0063, telephone, or e-mail. I further agree that my express permission to fax, telephone, or e-mail such notices and other information will continue and have no date of expiration.Print Full Name (s)TitleName of CompanyFax Number (s)SignatureDateReturn To:SPAL1731 SE Oralabor RoadAnkeny, Iowa 50021Or, Fax to: 800-654-7725**You must complete this form even if you do not wish to be contacted. Please indicate thatyou DO NOT wish to be contacted. **Page 3 of 3