4 Cottage Blvd.
Hicksville NY, 11801
Phone: (516) 203-7290 Fax:( 516) 515-9869

IMPORTANT! All information must be filled out as THOROUGHLY and ACCURATELY as possible.

Bus. Name: ______________________________ Mailing Address: ___________________________________

Phys. Address: ________________________City:_______________________State:_____ Zip Code________

Bus. Phone: (_____)_____________Fax:(____)______________E-Mail Address: _______________________

Web Address: ____________________ Fed Tax ID# _____________ Must include copy of certificate w/application.

Re-Sale Tax ID: _____________________ Must include copy of certificate w/application.

Days & Hours of Operation: _________________________________________

           Company is:                    ___Sole Proprietor                  ___Partnership                        ___Corporation

Yrs in Business: _________ Annual sales (est.) $_______________ If Incorporated, what yr._________
          Owner Information:   (If more than one owner, please include information on additional page)

 First Name: _________________________Middle ________            Last Name:________________________

Address:________________________ City:_____________________ State: ________  Zip Code: __________

Home Phone:(____)   ______________Mobile#:(____)____________ Social Security #______-______-______
                                                              CREDIT REFERENCES

Bank:__________________________________________       Phone:( ____)____________________________

Address: _______________________________ City; ________________ State_______ Zip Code: _________ 

Account #: ____________________ Banker: _______________________ Fax #: (___)_________________
                                        See other side to list Supplier/trade CREDIT REFERENCES.

      Open line of credit Requested: $___________    Accept COD ____ Credit Card ___? Yes __ _No ___
We acknowledge receiving a copy of this application and declare My/Our willingness to abide by D.R. Outdoors Inc. products terms of payment .It is also agreed that we will pay a late fee of 9% per month of the total amount past due and should a default in payment occur, My/Our Company will pay all reasonable collection costs, attorney fees and court expenses. In consideration of D.R. Outdoors Inc. extending credit to My/Our Company, we as officer(s) or owner(s) do personally guarantee and indemnify D.R. Outdoors Inc. against loss or indebtedness from My/Our Company. This guarantee shall be a continuing and irrevocable guaranty, which shall be binding upon me/our legal representatives. Notice of default is waived. Information provided on this form is given for the purpose of obtaining credit and is warranted to be true; D.R. Outdoors Inc. is authorized to contact the Credit References on this application,(includes my bank reference) as well as credit reporting agencies to verify My/Our credit/financial/payment history along with any commercial and/or consumer credit reports.

Signed X______________________________________                                                           DATE::_________________________
                                                                                           (1 of 2pages)

                          This credit application applies to all D.R. Outdoors Inc. Products lines.

                                    Additional Information and Trade Credit References
                                                                               For  

Your Business Name:________________________________________________________________________

Summer Hours:_____________________________________________________________________________

Winter Hours: ______________________________________________________________________________

                                  Supplier / Trade Credit References (Important to include fax # )

Supplier:___________________________________________ Phone: (____)___________________________

Address: _______________________________ City: _____________________ State: ______ Zip: _________

Account #: _________________________ Contact: ____________________ Fax #: (_____)_______________

Supplier:___________________________________________ Phone: (____)___________________________

Address: _______________________________ City: _____________________ State: ______ Zip: _________

Account #: _________________________ Contact: ____________________ Fax #: (_____)_______________

Supplier:___________________________________________ Phone: (____)___________________________

Address: _______________________________ City: _____________________ State: ______ Zip: _________

Account #: _________________________ Contact: ____________________ Fax #: (_____)_______________

                                         Previously submitted orders/Date: ______________

                                         Submitting Orders with this credit application:____

                     Please check if you need catalog, price list, or sales rep to contact you:

         1. Need Catalog _______ 2. Need Price List _____ 3. Need Sales Rep to contact me ______

Signature of credit Application: X ____________________________________ Date: __________________
                                                                          (2 of 2 pages)

                                                  NO PO BOXES ADDRESS WILL BE ACCEPTED   

                    This signed credit application applies to all D.R. Outdoors Inc. product lines.