RENEWAL APPLICATION FORM
ACCREDITATION OF REPAIR AND SERVICE SHOPS
(Please submit one copy)

 

______________________
Date                

1. Name of Applicant	:
2. Business Name	:
3. Business address	:
(Attached xerox copy of your Comprehensive insurance Policy & receipt of Payment and Financial Statement for the preceding year.)

4. (a) Single Proprietorship			Corporation
Partnership			Cooperative
(b) Present Value of Capital Invested		:
(c) Number of Employess		:

OFFICERS OF THE CORPORATION OR PARTNERSHIP

5. Certificate of Accreditation Number		:
Classification	:
6. Date Approved	:
7.Type of Accreditation Applied For		:
8. State below any particular changes in facilities, tools, equipment and personnel as previously declared in the original application

NOTE:
             COMPREHENSIVE - To include damage to the establishment and damage or loss of customer's property accepted for repair and others.

            That applicant in addition to the above data and information hereby incorporate by reference all other data and information submitted in connection with the original application.

            

______________________________
(Name of Firm)             

 

By:      ______________________________
Owner/Manager/representative