Please fill in the necessary information, print out the form, sign it and either fax or e-mail it as an attachment to The Mat King:
Company Name: _____________________________
City: ___________________ State: ________ Zip Code: __________
Phone Number: __________________
Fax Number: ____________________
E-Mail address: ________________________.
I ________________________ agree to indemnify and hold harmless Jandru Mats, Inc. d/b/a The Mat King and any and all of its officers, employees and agents or sources of product from any and all claims of whatsoever nature and kind including, without limiting the generality thereto, injury to persons, damage to property and claims for economic loss, arising out of the construction, installation, quality of goods supplied hereunder, or from anything undertaken or done in carrying out our contract.
Print Name: ______________________
Position with Company: _____________________
Date: _____/ _____/ _____
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3000 Hempstead Turnpike; Suite 305
Levittown, Long Island, NY 11756 USA
Fax: 800-Mats-Fax (628-7329)