Rental Customer Account Application

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Contact Information
Rent
Bank Reference

PAYMENT TERMS: COD

PAYMENT METHODS: CASH, AUTOMATIC CREDIT CARD OR BANK DEBIT

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I understand past due accounts may be subject to interest charges at a rate of 2% per month, 24% per annum.

I agree that the information given above is accurate and complete.

I authorize PRIMEMAX ENERGY INC. to conduct credit checks or obtain any information required to establish or verify my financial standing for the purpose of this credit application. I also agree to comply with the terms and conditions of sale as stated above.

In compliance with the Privacy Act, this information is not distributed to any other party, or used in any other way, except for the purpose stated above. This information is considered private and confidential.

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