DOLD APPLICATION FOR CREDIT ACCOUNT COMPANY NAME ............................................................. 
  COMPANY INVOICE ADDRESS ............................................................. 
  ............................................................. ............................................................. 
  ............................................................. E-MAIL ADDRESS 
  ............................................................. TELEPHONE NUMBER 
  ............................................................. FAX NUMBER ............................................................. 
  DELIVERY ADDRESS IF ............................................................. 
  DIFFERENT FROM ABOVE ............................................................ 
  ............................................................. YOUR NAME (Printed) 

  ............................................................. TYPE OF BUSINESS 
  
 ............................................................. .POSITION ............................................................. 
  SIGNED I have read, understood and accepted the Dold Industries Ltd. Conditions 
  of Sale: ............................................................. Date................................... 
  ............................................................. 
 
  Please can you send me further information on the following DOLD products;
  Safety Relays Measuring Relays
  Pump Control And Monitoring
  Motor Control products
  Timer Relays Annunciator Relays
  Solid State Relays