FINANCIAL INFORMATION REQUEST FORM

Your company name was given to Celesco Transducer Products, Inc. as a Credit Reference and you have been authorized to release the requested financial information by:

Please complete the Sections listed below and return completed form to Celesco as soon as possible.

ACCOUNT HISTORY
Date Account Opened:	Average Balance:	Line Of Credit:
Account Balance: (High)

PAYMENT RECORD
Excellent:	Good:	Fair:	Poor:

CUSTOMER'S CREDIT IS CONSIDERED:
Excellent:	Good:	Fair:	Poor:
Recent High:		Balance:	Terms:

COMPLETED BY:
Name:	Date:
Title:
Comments:

Thank you for your cooperation. Credit Department

Copyright(c) 1999 Celesco Transducer Products, Inc.