Charge Account Form

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Billing Information

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Is your company bonded?

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If yes:

Company Ownership Information

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Terms

I the undersigned, hereby authorize Dance Investments, LLC., d/b/a: “Almighty Rentals” (“A.R.”) to initiate:

automated charges of the above identified debit and/or credit card up to 150% of the new retail value of the “Rented Item(s)” identified in each “Rental Contract” (as identified below).

To the maximum extent permitted under applicable law, A.R. shall be entitled to bill to the above identified debit/credit card(s) all charges, known or unknown, accrued or unaccrued (including without limitation, all rent and overtime, as well as all charges for delivery, installation, maintenance, repair, replacement, removal, retrieval, cleaning, packing, taxes, fines, fees, assessments, attorneys’ fees, collection costs and costs of court) due and coming due in connection with any and all rentals of personal property from A.R. to myself and/or the above identified Customer (each, a “Rental”) up to an amount equal to 150% of the new retail price of each such rented item, plus all associated interchange and other card acceptance fees (the “Authorized Amount”). I acknowledge that: (a) each Rental will be subject to the terms of the Rental Contract I have executed with A.R., a copy of which Rental Contract I have received and carefully reviewed (each, a “Rental Contract”); and (b) I have received written notice of the new retail price of each Rented Item referenced therein. Accordingly, I irrevocably and unconditionally waive any and all claims, setoffs, chargebacks and counterclaims with respect to the above referenced charges. Additionally, to the maximum extent permitted under applicable law, I the undersigned, hereby: (i) authorize A.R. to: (A) retain a complete copy of my debit/credit card(s) and all information included thereon until this Authorization is revoked or terminated as provided below; (B) submit for payment on each such card all of the above referenced charges (including the Authorized Amount), without additional signature or authorization by me; (ii) make, constitute and appoint A.R. as my attorney-in-fact to execute and deliver, in my name, place and stead, all authorizations that may hereafter be required by any third party(ies), including card issuers, in order to give full effect to this Authorization (such power being durable, coupled with an interest, and not affected by my disability); and (iii) release, and agree to indemnify, defend and hold harmless A.R., its agents and employees, for, from and against all liabilities, claims, damages, losses, costs and expenses (including attorneys’ fees) arising from or in connection with the foregoing and/or any declination or reversal of such charge(s).

This Authorization supplements each Rental Contract, and will remain in effect until the last to terminate of all current and future Rentals, and thereafter until A.R. has received written notice of the undersigned’s revocation or termination hereof, at such time and in such manner as necessary to afford A.R. a reasonable opportunity to act upon such notice. I, the undersigned, hereby: (a) agree to take such actions as may be necessary or appropriate in order to give full effect to the terms of this Authorization; and (b) PERSONALLY GUARANTEE the prompt payment and performance of all obligations now or hereafter owing to A.R. under or in connection with this Authorization and/or each Rental Contract.

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