To Warehouse Sound Systems Pty Ltd

I offer the following information to support my application for payment by cheque or credit card be accepted from the following business enterprise:

Proprietor/Guarantor

Home Address

BH Phone

Mobile

AH Phone

Trading Name

Trading Address

BH Phone

Mobile

Fax

Proprietry Name

Registered Address

BH Phone/Mob

Fax

ABN No

ACN No

Email

web site

The financial institution from which I will normally transfer funds is:

Trading Name

Address

BH Phone/Mob

Fax

You may contact the following persons to verify my trading history:

Trade Referee

Address

BH Phone

AH/Mobile

Trade Referee

Address

BH Phone

AH/Mobile

Trade Referee

Address

BH Phone

AH/Mobile

Personal Guarantee:

I offer the above information so that Warehouse Sound Systems Pty Ltd will agree to rent equipment to the abovenamed enterprise and accept payment by cheque or credit card from the enterprise.

I guarantee payment for all fees and rental charges for equipment supplied to the enterprise, until the equipment is returned.

I accept full responsibility for the safe return of equipment, and agree to indemnify Warehouse Sound Systems Pty Ltd for all loss or damage to equipment supplied to the enterprise.

I authorise Warehouse Sound Systems to contact the abovenamed to assist in assessing this application.

Guarantor

Witness

Signature

Date

Signature

Date