— Auto-kool

Date: *

Trade name: *

Individual:

Partnership:

Corporation:

Business Address: *

Postal Code: *

Phone *

Fax:

Contact E-mail: *

Invoicing E-mail:

Statement E-mail:

NAME(S) AND RESIDENCE ADDRESS(ES) OF OWNER(S):

Name(s)

Address(es)

City/Province

Phone No.

Type of business: *

GST number:

Number of years in business:

BANK NAME:

Name

Address

City

Phone

TRADE REFERENCES:

Name

Address

City

Phone

This application is made with the understanding, and agreement, that all charges for parts and services work are due and payable on receipts of monthly statement, and subjects to a late charge of 1 1/2% per month (18% per annun) if unpaid by the 15th of the month following the date of statement. The late charge is not as an alternative to payment when due.

The authorized signer(s) is (are) jointly and severally responsible for any indebtedness of his (their) company towards AUTO-KOOL.

Authorized signer(s): *

Title: *

Authorized signer(s): *

Title: *

MONTRÉAL: 2295 52ND AVENUE, LACHINE, QUÉBEC, H8T 3C3 • TORONTO: 151 CARLINGVIEW DRIVE, UNIT #10, ETOBICOKE, ONTARIO, M9W 5S4 • OTTAWA: 2760 SHEFFIELD ROAD, OTTAWA, ON K1B 3V8 • MONCTON: 357 BAIG BLVD., MONCTON, NEW BRUNSWICK, E1E 1E1 • DARTMOUTH: 40 THORNHILL DRIVE, UNIT #1-2, DARTMOUTH, NOVA SCOTIA, B3B 1S1 • MOUNT PEARL: 103A CLYDE ROAD, MOUNT PEARL, NL A1N 4S1 • VANCOUVER : 4265 PHILLIPS AVE., BURNABY, BRITISH COLUMBIA, V5A 2X4 • EDMONTON : 17310 116TH AVE., EDMONTON, ALBERTA, T5S 2X2