LEISURE CONCEPTS INTERNATIONAL, INC.CREDIT APPLICATION

Phone (800) 652-4524

Leisure Concepts International, Inc.2745 Kiowa Blvd., North #101Lake Havasu City, AZ 86404 Fax (928) 854-1455

General InformationBusiness Name:Business Phone #: Fax #:Billing Address: Shipping Address:

Type of Business (please circle one): Proprietorship Partnership Corporation

If Subsidiary, Name of Parent Co.:Address:Phone #: Fax #:Federal Tax ID# Resale ID #How long in business: At this address:

Officers/Principals:Name: Name:Title: Title:Address: Address:

Home Phone #: Home Phone #:

Bank Reference:Bank Name: Contact:Branch Location: Title:Address: Types of accounts held:

Acct #:Phone#: Fax #:

Trade References:Company Name: Contact:Address:Phone #: Fax #:

Company Name: Contact:Address:Phone #: Fax #:

Company Name: Contact:Address:Phone #: Fax #:

The above named applicant hereby makes application for credit and provides the information contained herein for the purpose of inducing Leisure Concepts International, Inc. to make periodic sales of goods to applicant on credit. It is agreed and understood as follows: (1) the undersigned representative of applicant is duly empowered to enter into and make binding agreements on behalf of applicant: (2) the applicant represents that all the information contained in the financial data provided and any attachments are true and correct to the best of its information, knowledge and belief: (3) should credit availability be granted by Leisure

Concepts International, Inc: (4) applicant agrees to provide to Leisure Concepts International, Inc. upon request, updated financial information and a revised credit application, as conditions for the continued extension of credit: (5) terms are COD or net 30, account balance payable in full within thirty (30) days of invoice and

(6) in the event of default of payment when due, all costs of collection, including attorneys fees and court costs, shall be paid by the applicant.

Signature: Title:Printed Name: Date:

For office use only: Approved or Denied by: date: