ONLINE FORM

*Company Name: *Legal Name: (hereinafter referred to as the "Company")

*Address: Number & Street *Town *Province *Postal Code

*Email: *Telephone: *Fax: Cell:

Address: Number & Street Town Province Postal Code

Email: Telephone: Fax:

*Name: *Title:

Name: Title:

*Purchasing Agent: *Tel: *Fax:

*A/P Contact: *Tel: *Fax:

*Date Business Started: *Type of Operation:

*Legal Status:     Corporation    Partnership     Proprietorship     GST Registration #:

*Amount of credit required: *Bank Name:

*Bank Address: Number & Street *Town *Province *Postal Code

*Account Number: *Type of Account: *Contact: *Tel: *Fax: savings  chequing

Company Name Address: Number & Street Town Province Postal Code

Contact: Tel: Fax:

Company Name Address: Number & Street Town Province Postal Code

Contact: Tel: Fax:

Company Name Address: Number & Street Town Province Postal Code

Contact: Tel: Fax:

Certificate #: Expiry Date: Name of Holder:

Certificate #: Expiry Date: Name of Holder:   Note: This means the person whose pesticide certificate number is used accepts the responsibility and liability for the transportation, storage and use of the pesticides listed on the invoice.

The Company hereby applies to Plant Products for extensions of credit on the usual trade terms of Plant Products from time to time in force to enable the Company to acquire products from Plant Products. Nothing herein shall bind Plant Products to extend credit or to sell products to the Company. For value received, the Company hereby agrees to pay to Plant Products all indebtedness, liabilities and obligations of the Company owed to Plant Products from time to time, together with interest and other sums owing pursuant thereto (collectively, the "Obligations"). All Obligations shall be paid by the Company without any right of deduction, set-off, compensation, counter-claim or other defense. For accounts past due, interest shall be charged at 18% per annum. The Company hereby represents and warrants to Plant Products that: (a) it is validly existing and has full right, power and authority to enter into this agreement and to perform its rights and obligations hereunder; (b) it has the financial ability and willingness to pay for all invoices issued by Plant Products within established terms; and (c) all information supplied by the Company for this credit application, including without limitation the Company's legal name, is true and correct, and the Company will immediately notify Plant Products in writing of any change in such information. The Company hereby authorizes Plant Products to make investigations of its credit standing for which this application has been made, as deemed necessary by Plant Products This Agreement shall be governed by the laws of the Province of Ontario.

*Dated This *Day Of *Year *Company Name *Name: *Title:   x   Company Name Name: Title:   x   *I/we have authority to bind the corporation.  *I/we have read the terms and conditions.     Please check all information is correct and accurate, then press print for your signature. Please scan and email to debbie.storms@plantproducts.com  or fax back to Debbie Storms at 519-326-9290.