DEPENDO RENT-ALL INC.

1999 LAFAYETTE RD FT. OGLETHORPE GA. 30742

PHONE 706-8666845 OR FAX 706-8666845

www.dependorent-all.com

APPLICATION FOR CREDIT

NAME OF FIRM__________________________________________________________________

ADDRESS_______________________________________CITY___________________

STATE________ZIP________PHONE________________________ FAX____________________

NUMBER OF YEARS IN BUSINESS________LINE OF WORK__________________

PARTNERSHIP____ SOLE PROPRIETORSHIP____CORPORATION_______

SS#__________________________OR FED. ID #_______________________________

PRINCIPAL MEMBERS OF FIRM

NAME__________________________TITLE________HOME PH._____________

BUSINESS REFERENCES

#1 NAME________________________________________PHONE______________

#2 NAME________________________________________PHONE_______________

#3 NAME________________________________________PHONE_______________

#4 NAME________________________________________PHONE_______________

NAME OF RENTAL STORE YOU HAVE ACCOUNT WITH NOW_______________

_______________________________________________________________________

IS A PURCHASE ORDER REQUIRED? YES____ NO____

LIST PERSONS AUTHORIZED TO SIGN____________________________________

_______________________________________________________________________

________________________________________________________________________

CUSTOMER AGREES TO PAY ALL BILLS NET ON RECEIPT AND AGREES TO BE

RESPONSIBLE FOR ALL COLLECTION REPOSSESSION, ATTORNEY'S AND

COURT COSTS INCURRED IN CONNECTION WITH THE COLLECTION OF

ACCOUNTS OWED.

SIGNED BY_______________________________OFFICER___________ DATE___________

(MUST BE SIGNED BY OFFICER)