The Downtowner Car Wash

Date: 08/28/08 Time: 05:54 PM

Company Name as Registered for Taxes
D/B/A if Different
Personal Name (if applicable):
Address
Street
Suite/Apt
City
State
Zip Code
Telephone
Fax
Contact Person
Federal Tax ID Number
Tax Exempt Number (If Applicable)
Estimated Monthly Volume
References
Please Include a contact name, their address, and their phone number.

Reference 1 Name
Reference 1 Address
Reference 1 Phone Number

Reference 2 Name
Reference 2 Address
Reference 2 Phone Number

Reference 3 Name
Reference 3 Address
Reference 3 Phone Number

Confirmation will be faxed to you upon approval.

For any questions regarding your account, please contact Michelle Montpetit at the number listed below. Thank you for your business, and have a great day!

Downtowner Car Wash
520 East 7th Street
St. Paul, MN 55101

Phone: (651) 222-7045
Fax: (651) 222-5019