DISCLOSURE TO CONSUMER AND CONSUMER AUTHORIZATION
FOR PROCUREMENT OF CREDIT REPORT
FOR THE PURPOSE OF EXTENDING CREDIT

CREDIT REPORT
A credit report will be obtained in connection with this application, for a renewal or extension of credit for which application was made. Upon request, I will be told if a credit report was obtained, and given the name and address of the credit-reporting agency providing the report.

CREDIT INVESTIGATION
I authorize YODER DAIRIES OF TIDEWATER, INC. to start a credit investigation based on the information voluntarily provided by me, which is true and correct.

TERMS
I understand the following: Effective September 1, 2003, there will be a delivery fee for each delivery made to my home. My bill is due and payable upon receipt. If my monthly bill exceeds $35.00 and the account is paid in full by the twentieth of the month, I will receive a discount of 4.5%. After the twentieth of the month, my account will be assessed a service charge of 1.5% monthly (18% APR). Should my account become delinquent, I will be responsible for all costs incurred in collecting the unpaid balance.

BANKRUPTCY
A bankruptcy proceeding is not in progress nor expected.

CONSUMER:

__________________________________ DATE	__________________________________ PRINT NAME
________________________________ ADDRESS	__________________________________ CITY     ZIP
________________________________ PHONE NUMBER	__________________________________ SOCIAL SECURITY NUMBER
________________________________ WORK PHONE NUMBER
_____________________________ SIGNATURE
5102 PRINCESS ANNE ROAD VIRGINIA BEACH, VA 23462-4242 PHONE (757) 497-3518 ** FAX (757) 497-3510