Account Activation Form

All fields are required unless marked as 'Optional'.

Community Information

Salesperson - Optional

Credit Line Desired - Optional

Apartment Community Name (the "Property")

Fee/Owner ManagedFee ManagedOwner Managed

Occupancy Rate - Optional

Total # of Units - Optional

Anticipated Monthly Purchases

Street Address

City, State, Zip

Manager's Name

Property's Phone

Property's Fax

Purchase Information

Payment Contact

Payment Phone

Payment Fax

Email Address (for billing purposes)

Purchase Order Required?YesNo

Invoices/Statements sent to - OptionalPropertyManagementOwner

May an order be shipped without a PO Number?YesNo

Tax StatusTaxableExempt

Does the flooring materials at this property contain asbestos? - OptionalYesNo

Year property was built - Optional

Please check all that apply if you use one of these e-procurement services - OptionalAvidXchange for InvoiceseSupply Systems for PurchasesOps Technology for PurchasesOps Technology for InvoicesSiteStuff for PurchasesSiteStuff for Invoices

Property Management Information

Property Management Company

Street Address

City, State, Zip

Property Management Company Phone

Fax

Legal Name of Entity that owns the Property - Optional

Street Address/Suite - Optional

City, State, Zip - Optional

Property Owner Phone - Optional

How many years you have managed this property? - Optional

If less than a year, how many months - Optional

If you prefer to receive invoices in pdf format what email do you want to receive these at? - Optional

We would like to implement 810 compliant EDI invoicing to our A/P department. Who should Rasa contact to implement this service for your Property?

Name

Phone

Other Special Instructions - Optional

Disclaimer and Signature

The information furnished to Rasa Floors & Carpet Cleaning, LLC ("Rasa") on this form is true and correct and is for the sole purpose of establishing an open account with Rasa for the purpose of purchasing flooring goods and services. Signer is authorized to bind the Owner of the Property for any and all purchases made from Rasa for the Property. All invoices are payable to Rasa at its offices in Carrollton, Denton County, Texas, and are due and payable within thirty (30) days of the invoice date unless otherwise agreed in writing. If the account is placed with an attorney for collection, the Owner agrees to pay Rasa its reasonable attorney's fees and costs incurred in the collection of the indebtedness. The Property agrees to pay interest at 18% per annum on all invoices not paid within thirty (30) days from the invoice date. If legal proceedings are brought to resolve a dispute, the parties expressly agree that venue shall be in Denton County, Texas.

By writing your name and date this Account Activation Form as an agent on behalf of the Property Owner, the Management Company is assuming NO liability for payment for goods and services sold to the Property. Rasa agrees to look solely to the Owner of the Property for payment of its invoices.

First and Last Name

Date MM/DD/YYYY

Your Title