Your Name:
Your Email:
Organization:
Street Address:
City:
Province/State:
Country:		Phone:
Postal Code:		Fax:
Type and Nature of Business:
How Long Established:
Partnership	Corporation	Proprietorship	Ltd. Co.
Current Job:
P.O.# Required   Yes	No

COMPANY PRINCIPALS:

1.:		Title:
2.:		Title:
3.:		Title:

TRADE REFERENCES:

Company 1.:		City:
Phone.:		Fax:
Company 2.:		City:
Phone.:		Fax:
Company 3.:		City:
Phone.:		Fax:

ACCOUNTS PAYABLE CONTACT:

Name.:
Phone.:		Fax:
PST Exempt:   Yes	No
GST Exempt:   Yes	No

BANK REFERENCES

Name.:		Contact:
Address.:		City:
Phone.:

We hereby authorize the above named references to disclose to Robinson Rentals & Sales (Division of 618970 British Columbia Ltd.) any information concerning our/my accounts.

Title:
Name:		Date:

In consideration of Robinson Rentals & Sales (Division of 618970 British Columbia Ltd.) agreeing to extend credit as requested above, We agree to make payment to Robinson Rentals & Sales (Division of 618970 British Columbia Ltd.) of their accounts rendered within 30 days of the date on which each account is rendered. We further agree that if payment is not made within 30 days of the date on which the account is rendered, interest shall, be paid at the rate of 2% per month (24% per annum) on the amounts unpaid. Robinson Rentals & Sales (Division of 618970 British Columbia Ltd.) may terminate this agreement at any time upon notice whereupon all balances, including interest shall become immediately due and payable.

Title:
Name:		Date:

GUARANTEE:

In consideration of Robinson Rentals & Sales (Division of 618970 British Columbia Ltd.) extending credit as requested above to I hereby personally guarantee payment of all monies owing from time to time by together with interest as set out above.

Title:
Name:		Date: