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Gardner Denver, Inc.

Credit Application
Company Name: Compressor & Blowers Service_______ Phone: +504 2556-5684__________________

Street: Res. Altiplano, 19 Ave., entre 24 y 25 calle,_______ Fax: __________________________________


City: San Pedro Sula_______________________________ State: Cortes_____ Zip:_21104_________

A/P Contact: Sergio Arturo Serrano Crcamo__________ A/P E-mail: sergio.serrano@combloser.com__

A/P Fax: ________________________________________ A/P Phone: +5049540-8058________________


D.U.N.S. #:_____________________________________

Account Statement Delivery Preference: Invoicing Delivery Preference:

Email / sergio.serrano@combloser.com Email / sergio.serrano@combloser.com


Fax:____________________________________ Fax:_____________________________________

Business Type:
___ Corporation ___ LLC ___ Sole Proprietorship ___ Partnership ___ S-Corporation
_X_ Other (please explain)_Sole Trader____________________________________________

Are you associated with a Parent Company: Y / N Parent Company Name:__________________________

Parent Company Address:____________________________ City:________________ State:____ Zip:________

Is Your Company Tax Exempt: Y / N If Yes, Please Provide a Copy of Each Applicable States Certificate

Estimated Total Monthly Requirements: $__4,500.00 to 5,500.00____________________


**If Monthly Requirements Are Expected To Be Greater Than $50,000.00, Your Most Current Audited Financial
Statements Must Accompany This Application**

Bank Reference

Name: Banco de Occidente Address:_San Pedro Sula, HN_____ Phone:+5042545-7000 Fax:______________

U.S. Trade References

Name: _ eCompressedair ___ Address: 251 union street, Westfiel,MA 01085 Phone:413.562.2324_
Email /kim.cottengim@ecompressedair.com Fax: ____________________

Name: Industrial Compressor Supply Address: 316 fee fee Rd.,Maryland heights,MO63043 Phone: 877.426.3131_
Email /Dawn@eaircompressorparts.com Fax: ____________________

Name: _ Ring Power ___ Address: 3400 N.W. 77 Th court,FL 33122 Phone:413.562.2324_
Email /denis.caja@ringpower.com Fax: ____________________

Note: Past Due Account Balances Are Subject To An 18% Per Annum Service Charge

Signature:____________________________________________ Date:_13-03-2017_____________________
(Authorized Officer of Company)
Title:________________________________________________

Return the Completed Application to Fax (217) 228-8267, Attention: Vicki Kuhlmeier.