Force Control:electric brake manufacturer:servo drive:dynamometer:position control:clutch brakes

FORCE CONTROL INDUSTRIES, Inc. 3660 Dixie Hwy. Fairfield, OH 45014	FORCE CONTROL INDUSTRIES, Inc. P.O. Box 18366 Fairfield, OH 45018
Phone: (513) 868-0900 FAX: (513) 868-2105 Please print out the form, fill in, and mail or fax to the above address

Name of Company:	_________________________________________
Duns#	_________________________________________
Address:	_________________________________________
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Phone:	(___)__________________
FAX:	(___)__________________

Purchasing Agent/Buyer:	____________________________________
Accts. Payable Supervisor	____________________________________

Corporation: State of Corporation:

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Year:

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Chief Executive Officer:

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If Subsidiary: Name Parent Company:

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Bank:	__________________________________________________
Phone:	(___)____________

Account #	______________________________________
Bank Officer or Contact:	______________________________________

Credit Extended by at least three major corporations:
(Include Addresses, Phone Numbers, and Contact)

Name	Address	City/State	Fax
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We understand that if terms are extended, they are 1/10, N/30, and agree to pay 1-1/2% per month service charges whenever we fail to do so. No Changes or alterations to this agreement are acceptable.

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