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PREPAID TRUCK TOLL ACCOUNT AGREEMENT Point Edward, Ontario N7V 4J5 Phone: (519) 336-2720      Fax: (519) 336-7622      www.bwba.org
The first time that a card in your name is used, it will mean that you have accepted this agreement in its entirety and you will be responsible for every use of the card(s) issued to you from time to time. You agree to keep your account balance above $0.00 at all times. If your account falls below the $0.00 balance, you agree to any interest charges and collection costs including legal fees and disbursements on a solicitor and client basis.
PREPAID TRUCK TOLL ACCOUNT APPLICATION 1 Bridge Street Name of Company Account ____________________________________________________ Name to Appear on Card ______________________________________________________ Address______________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Contact _____________________________________________________________________ Title ________________________________________________________________________ Phone ______________________________________________________________________ Fax _________________________________________________________________________ Estimated monthly crossings (in dollar value) ____________________________________ Number of prepaid toll cards required __________________________________________ Name that appears on cab of truck _____________________________________________ The undersigned agrees to abide by the terms and conditions of
the Agreement on the reverse of this Application. If this Application is completed
on behalf of a Corporation, the undersigned expressly warrants that this agreement
is binding upon the Corporation and the undersigned has the authority to bind
the Corporation. Signature
___________________________________________________________________ Name and Title
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