Order Confirmation Form

ORDER CONFIRMATION FORM (Tank Rental) 401 Hwy. #4, PO Box 879 Biggar, Saskatchewan, Canada S0K 0M0 PH: 306-948-5262 FAX: 306-948-5263 EMAIL: [email protected] WEB: www.Envirotank.com 1-800-746-6646 Sales Rep:______

Customer Name: Billing Address: Street City Province Postal Code Shipping Address: Street City Province Land Location: Customer Contact: Name Phone# Fax# Bank Information: Please attach a void cheque 1. Contractual terms: 1. By signing this “ Order of Confirmation” your firm is accepting of the terms and conditions described below. 2. AGI-Envirotank retains title on this property and will register a Personal Property Security Agreement against it. 3. Any damage to said property during the rental period is the responsibility of the renter. 4. Upon return of the rental tanks to AGI-Envirotank, the renter will be responsible for all cleaning costs associated with their use of said property . II. Rental Warranty: 1. AGI will make sure all equipment is in good order before renting the tank. 2. If the tank or equipment is found to be defective AGI’s liability under this warranty shall be limited to; at our option, (A) repair of the defective tank, (B) delivery of a replacement tank, or (C) refund of the original rental, and we shall not be liable for any labour, other installation costs, indirect or consequential damages or other damages in connection with such tanks. 3. AGI does not warranty or repair disposable items. For example nozzles and filters. AGI ships spare filters and nozzles with our rental tanks. III Payment Terms: Unless otherwise identified and attached, are as follows: 1. AGI is to be paid via pre-authorized payment. 2. First & last months' rent, & freight costs payable at time of delivery 3. Lessor is hereby authorized to periodically draw payment under its Pre-Authorized Payment Plan from the bank account specified in the "Bank Information" section above and / or as outlined on the attached sample cheque (the "Specified Account") to cover the Rental and other amounts due under this Agreement. (PLEASE ATTACH UNSIGNED SAMPLE CHEQUE) 4. Is your company GST exempt?______If yes, please provide your exemption #______5. Is your company PST exempt?______If yes, please provide your exemption #______III. Delivery Date The tank is required onsite ______. The tank will be picked up ______from AGI’s______yard. IV. The Order Payment Frequency: Rental Amount: Freight to site: Rental Period: Tank Serial #: Fuel Stored: Description / Quote #:

______Authorization Signature Title Company / Company Seal ______Print Name Date