XIUM CORPORATION

APPLICATION FOR CREDIT

Company Name:                                                                                                                                                                                            

Billing Address:                                                                                                                                                                                              

City:                                         _________________                  State:                   Zip:                  

Kind of Business:                                                                                                                                                                                            

                  Individual [   ]              Partnership  [   ]            Corporation [   ]               Year Established:                                      

           Owners & Officers                                 Position                                    Home Address                                    Home Phone

Bank Reference:                                                                                          Phone:                          Contact:                                                

Address:                                                                                                                                   Type of Account:                                          

City:                                                                                 State:                                        Zip:                         

Fax Number of Bank:                                                                                                                             (To expedite Credit Approval)

Trade References: (Do not include credit cards, utility or fuel accounts)
                    Name                                                Address                                              City, State, Zip                              Phone

Fax No.'s of Trade References: 1.                                        2.                                        3.                                    

Taxable or NonTaxible (Federal ID Number):                                                                                                                                                

*****PLEASE READ BEFORE SIGNING*****

The person whose signature appears below understands and agrees to abide by our credit terms of net 30 days from date of invoice. It is also agreed that credit terms extended beyond our normal term will bear simple interest at the rate of 18% annum.

Date:                           Signature:                                                                                       Title: