Please print off and fax to #219.4241

How did you hear about Top Dog Courier? ________________________________

Company name: ____________________________________________________

What industry to you work in? _________________________________________

Main contact: ______________________ e-mail: __________________________

Phone # __________________  Fax #______________________

Mailing address: ____________________________________________________

City: ____________________ Province: ___________________ P/C: __________

How much do you usually spend on a courier monthly? _______________________

What do you dislike about your previous courier? ___________________________

Will you still be using another courier besides us? ___________________________

If so, what could we do to get all your business?_____________________________

Please provide 1 vendor for credit reference: _______________________________

Contact name: __________# ___________ address: _________________________

__________________________________________________________________

Terms & conditions:

Please note payment is due immediately upon receiving invoice (15 days).  6.5% monthly compounded

interest will apply on all overdue accounts.  No minimum or maximum usage required,

no monthly fees or fuel surcharge will apply.  Please request a rate sheet for further information.

5% GST will apply to all invoices, to get a 1% discount sign up for our pre-authorized payment plan.

(our pre-authorized payment plan will be billed to your credit card when invoice is printed, then

mailed to you with your receipt.  This will keep your account in good standing, receive a 1% discount

and you have the opportunity to take advantage of your cards point system.)

For credit accounts- company checks can be mailed to:

Top Dog Courier

Lock Box B9371, PO Box 9100, Station F

Toronto, Ontario. Canada M4Y3A5

I agree to the terms listed above: x ________________________________

Print:______________________ position: _________________________