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GENERAL INFORMATION                                                                  * SECURE CREDIT FORM *
BUSINESS INFORMATION

COMPANY NAME IN FULL

BILLING / MAILING ADDRESS


CITY
PROVINCE/STATE
COUNTRY
POSTAL CODE/ZIP CODE

PHONE
FAX
EMAIL ADDRESS


NAME OF ACCOUNT REP. (if applicable)




 PRINCIPLE(S) INFORMATION

PRINCIPLE (1)

ADDRESS

CITY
PROVINCE/STATE
COUNTRY
HOME PHONE


BANK INFORMATION

BANK (1)

ADDRESS

CITY
PROVINCE/STATE
COUNTRY
PHONE
MANAGERS NAME



CONTACT NAME


SHIPPING ADDRESS


CITY
PROVINCE/STATE
COUNTRY
POSTAL CODE/ZIP CODE

IS YOUR BUSINESS A




NATURE OF FIRM'S BUSINESS

YEARS IN BUSINESS





PRINCIPLE (2)

ADDRESS

CITY
PROVINCE/STATE
COUNTRY
HOME PHONE




BANK (2)

ADDRESS

CITY
PROVINCE/STATE
COUNTRY
PHONE
MANAGERS NAME



  TRADE INFORMATION

      TRADE REFERENCES
 1.   FAX   PHONE
 2.   FAX   PHONE
 3.   FAX   PHONE
 4.   FAX   PHONE


  ADDITIONAL INFORMATION

  Has company made an assignment of its accounts receivable and/or debenture
  or floating charge over its assets   

  ASSIGNMENT(TO WHOM GIVEN)          DATE
  DEBENTURE      (TO WHOM GIVEN)          DATE

  CREDIT LIMIT REQESTED (MONTHLY)  $

  PURCHASE ORDER NUMBER REQUIRED   


                                    CREDIT AGREEMENT - TERMS AND CONDITIONS

 In consideration of $1.00, receipt of which is acknowledged, BRITE-LITE "Supplier" permitting the purchase of goods and
 services on a credit basis, there herein mentioned applicant hereby agrees to the following terms and conditions.
 1. PAYMENTS:
       I (we) agree to pay all invoices and other charges 30 days following the date of purchase.
       I (we) agree to pay all service charges levied against the account as a result of late payments. It is understood that
     service charges shall be payable at the rate of 2% per month (24% per annum) in the indebtedness overdue, or at such
     other rates as may be notified to me by ordinary mail from time to time, and shall be calculated on each statement date
     being the last day of each month, based on the date of each sale as debted to the account.
       I (we) agree to pay all charges made to the account if purchases authorized by any person in our (my) employment.
       I (we) also agree to be held liable for all purchases made to the account, authorized, unless we have specifically
     supplied with a written list of names authorized to charge to the account.

 2. MISCELLANEOUS:
       I (we) agree to promptly notify the supplier of any change of address.
       I (we) agree that the Supplier shall have the right to cancel this agreement at any time without notice to the applicant.
     Any balance owing time of cancellation shall become due and payable immediately.
       I (we) agree to hold the Supplier harmless to the inconvenience whatsoever, caused by either a temporary or
     permanent withdrawal of credit privileges whether or not I (we) have received any advice of such withdrawal.
       I (we) acknowledge receipt of all merchandise delivered to me (us) in accordance with our shipping instructions,
     and that no further acknowledgements or acceptances are required to obtained by the Supplier.
       I (we) agree to pay all collection costs including solicitor costs on a solicitor and client basis which may arise from
     non-payment of the account.
       I (we) agree that the Supplier may obtain credit and/or personal information as may be required at any time in
     connection with the credit hereby applied for any renewal or extension thereof and I (we) agree to the disclosure of any
     credit information concerning the account in any credit reporting agency or any person with whom I (we) have or
     propose to have financial dealings.
    I (we) agree that the Title of the Products Remain With Supplier Until Full Payment has been Received.
   I (we) have read and accept its terms and conditions.  Yes  No


   DATED AT         THIS        DAY    YEAR

   APPLICANT'S SIGNATURE    TITLE
ADDITIONAL CREDIT INFORMATION