Contemporary Communications, Inc.
             630 Pennsylvania  Wichita, KS 67214-4157
phone: (316) 265-0879  fax: (316) 265-2448  email: info@mailCCI.com

                        CREDIT APPLICATION                             

Name (Bill To) ____________________________________________________
Street Address ____________________________________________________
City _______________________________ State ______ Zip _____________
Phone __________ EXT# _____ Fax __________ Email __________________

Type Of Business __________________________________________________
Type Of Ownership   ___Individual  ___ Corporation  ___ Partnership

Years in business ________  Purchase Order Required ___ Yes  ___ No

Expected Monthly Purchase Amount $_____________

Contact Person for Payment:
Name _____________________ Phone _________________ Fax ____________

Primary Bank ______________________________________________________
Address ___________________________________________________________
Phone _________________  Account Number(s) ________________________
Fax ___________________  Account Number(s) ________________________
                         Account Number(s) ________________________

Trade References:                   

Name: __________________________   Name: __________________________
Address: _______________________   Address: _______________________
________________________________   ________________________________
Phone: _________________________   Phone: _________________________

Name: __________________________   Name: __________________________
Address: _______________________   Address: _______________________
________________________________   ________________________________
Phone: _________________________   Phone: _________________________

                 CREDIT RELEASE AUTHORIZATION

This form shall serve as authorization for release of any and all 
credit information from Banks, Trade Vendors, and other financial 
reporting organizations for the firm or individuals listed above.  
A photocopy or fax of this authorization is to be considered as 
valid as the original.

Company Name: ____________________________________________________

Individual Name: _________________________________________________

Title: ___________________________________________________________