Vendors Customers Staff - Canpro Office Phone numbers

Information for Prospective New Members
of the Canpro Buying Group 2014
g
n
ssi
i
M e
e
h
T Piec
s
r
o
d
n
e
V
s
r
e
m
o
st
Cu
f
S
f
a
t
Canpro which has been serving the needs of independent paint and wallcovering retailers since
1996, was formed to allow our members to remain competitive with the onslaught of the “big
box” stores that were then popping up across Canada.
From our initial 5 members in 1996, Canpro has grown to having 227 leading retailer store fronts
from Coast to Coast across Canada. In 2002 Canpro became a shareholder of the ALLPRO
buying group in the United States, which has over 1400 independent store fronts in the United
States, Canada, Ireland and Bermuda.
Canpro’s Mission Statement : “The mission of Canpro is to provide to our independent
paint and wallpaper Members a cost effective buying group that will collectively earn preferential
pricing and programs from our suppliers in exchange for the assurance that they as suppliers
will be paid within our agreed terms. It is our goal to attract the cream of the crop of independent
paint and wallpaper stores across Canada, defined not by the brands of products sold, or volume
but by their ability to fulfill the members obligations as set out in our participants agreement”
The obligations that are set out in the participants agreement are quite simple, to pay your bills
within our terms and policies and to support the programs offered by our suppliers.
If you are an independent paint and wallpaper store and want to improve your margins and
buying power then Canpro may be the answer.
Q.
Who can join Canpro?
Canpro membership is open
to independent paint retailers.
Canpro is not affiliated with any
one paint company, nor do prospective members have to be
of any specific volume, however members with sales of
$750,000.00 plus will realize an
excellent economic return on
their investment in Canpro.
Q.
Are all Canpro Programs
Centrally Billed?
Canpro is a central billing buying
group. All billings must be done
through the Canpro office.
Q.
What are Canpro’s Terms?
Canpro’s requires our members
Frequently Asked
to make only one payment per
month, with the payment to be
Questions about
received by Canpro no later than
the Canpro Buying Q. How does Canpro work? the 15th of the month following.
Canpro members purchase The monthly billing cutoff is typiGroup
product directly from our over cally the 26th of the month, and
100 approved suppliers. Pric- all statements and invoices are
Q. What is Canpro? Canpro is a ing from the suppliers is gen- sent on that date. If payment
Canadian buying group for lead- erally lower than individual is received by the 15th of the
ing independent paint & Wallpa- dealers would pay.
The sup- month following members will
per stores.
pliers invoice Canpro, whom in never miss discounts.
turn invoices the member for
Q. What happens if I don’t pay
purchases, adding a small
Q. What is Canpro’s mission? his
within Terms? The day after
upcharge for handling the transCanpro’s mission is to allow our
your payment was due to arrive
action. All Discounts offered by
independent members remain
at the Canpro office (or into our
the supplier are passed on to
competitive with the chains and
account) members whose paythe member. There is no hidden
box stores. As retailers we can
ment does not arrive will be given
central billing discounts.
only sell our products competia courtesy phone call, advising
tively if we buy them competi- Q. How much is the Upcharge? them that they have 24 hours to
tively.
Canpro strives to be as econom- get the deposit in, or the suppliical as possible, and has revised ers will be notified that they are
upcharge to reflect efficien- on credit hold.
Q. Is Canpro Controlled by a our
cies of scale and increased The term discounts offered on
manufacturer? No. Canpro is
efficiency in our administration. our Invoice Statement will be
not owned or controlled by any
Canpro now works on a 3/10 of billed back as unearned.
manufacturer. Canpro is owned
1% surcharge on all purchases,
by your peers, other indepenQ. One of my current suppliinvoiced monthly. The Canpro
dent paint and wallpaper stores.
ers terms are 2% 15th of the
board reviews the upcharge rate
month following net 60 days,
on an annual basis.
I take the 60 days? If the
Q. Is Canpro owned by Allpro? Q. How much will I save? The can
suppliers terms permit, yes we
No, Canpro owns shares of
savings vary greatly from sup- can arrange for the extra month,
Allpro Corp., which operates the
plier to supplier. Some of the provided that the net due date is
Allpro buying group, primarily in
savings will be at preferred pric- after our next payment cycle.
the U.S. Canpro is a full voting
ing, some by better payment
member of Allpro, and our memQ. Some of the suppliers usudiscounts and some by group
bers have access to all of the
ally give me booking orders and
volume rebates, from the supAllpro programs. The cost of
extended terms Many Canpro
pliers that offer volume rebates
belonging to Canpro is a fraction
suppliers offer extended terms
programs. The savings are sigof the cost of belonging to Allpro.
on promotion orders, and Canpro
nificant.
passes this additional time on to
our members.
Q.
How much does it cost to
join Canpro?
Membership is only $75.00 per
month, In addition there is a
one time payable $5000.00 fully
Refundable security deposit.
The security deposit is fully
refundable if your firm leaves the
Q. If Canpro automatically takes buying group in good standing.
advantage of suppliers terms
discounts, what happens if the Q. Does Canpro pay interest
supplier offers a prepayment on the security deposit? Yes,
discount on a long term invoice? Canpro pays the member interCanpro assumes that most est at no less than the Bank of
of our members want to take Canada annual rate on Decemadvantage of term discounts. ber 31st. Interest is paid into
However if a member wishes to the members deposit account.
take advantage of longer terms, Q. I have two stores, do I have
the member can simply advise to pay the membership for each
the Canpro office, that you wish store? No, as long as the stores
to take the longer terms.
have the same ownership, then
branch stores are automatically
Q. How does Canpro do its a member, without extra cost.
so that we can take advantage of
supplier term discounts, sometimes before actually receiving
payments from our members.
join Canpro? All Canpro members are required to provide
to our chartered accountant,
annual financial statements. All
members are also required to
sign a participants agreement,
which includes a personal guarantee.
Q. What if I am not satisfied?
billings? The majority of the
invoices that come to Canpro
now come by edi (electronic data
interchange), usually the day
after the goods were shipped.
Canpro’s software automatically converts the data to a pdf
document and e-mail it to our
members. No special software is
required by the member.
Q. What else do I need to do to
Invoices that arrive on paper,
are processed by Canpro and
then scanned and emailed to the
members on a weekly basis.
of my other suppliers demand
a deposit, financial statements
or a personal guarantee, why
does Canpro? First of all none
of your other suppliers work on a
mark up of only .3%. With a .3%
markup there is no room for any
credit risk.
Once a month Canpro issues an
“Invoice / Statement” that summarizes all purchases made in
the month by supplier, and has
a net amount due on the 15th
of the month following. The
Invoice Statements also have
the Canpro surcharge shown.
These are emailed to members
on the cut off date each month.
Q. That is a little extreme. None
The purpose of the deposit is
two fold, one to give all members protection should a fellow
member’s business fail. Secondly the deposit provides all of
the working capital for the group,
The financial statements are
used to confirm that there is little
credit risk. The information on a
members financial statement is
confidential, no member or director of Canpro sees anything but
a risk assessment , a few ratios
derived from the statements.
Q.
What is the Participants
Agreement? The participants
agreement (product purchase
agreement) is simply the rules of
the group, outlining the groups
responsibilities and the responsibilities of the members. A
personal guaranty is part of
the participants agreement. A
sample copy of the agreement is
enclosed for your review.
Canpro members can resign at
any time, our approved suppliers
will be notified that the member
resigned, and as soon as all
invoices are issued and payments are received the members
deposit ($5,000.00 plus accumulated interest) will be refunded.
Q. Do I have to buy from Canpro
Suppliers?
No. Canpro members are independent dealers, and there is no
obligation to do business with
any particular supplier.
You
are free to purchase from whomever you choose, however you
will want to do business with as
many of our suppliers as possible to ensure an excellent return
on your investment in the group.
Q. Does Canpro stock product Q.
Whom are the approved
Suppliers to Canpro? Canpro’s
suppliers are likely to include
many of the suppliers that your
are currently purchasing products from. A partial listing of the
current suppliers is included in
package. We are always
Q. How do I get the supplier this
Q. I want to join Canpro to take information? Canpro has a mem- looking for new suppliers and
advantage of one suppliers pro- bers resource website, with all of welcome suggestions from our
gram. Canpro members are the basic information about each membership. In addition to the
required to purchase from multi- of the suppliers programs. This Canpro Suppliers, Canpro memple suppliers. No single supplier includes information on all cur- bers have full access to the over
can be over 85% of a members rent Canpro and Allpro suppli- 120 supplier programs of the
Allpro Buying Group. There is
purchases.
ers, and in many cases includes
no additional charges to access
Q. Will all Approved suppliers the suppliers Catalogues. The the Allpro Programs by Canpro
sell to all Canpro members? No. approved suppliers will also con- members.
Our approved suppliers main- tact the members with periodical
tain the territorial rights of their updates, new products and sales Q. Does Canpro have meetproducts. If a supplier feels that presentations. New suppliers ings? Canpro has an annual
his product is adequately distrib- and products are often featured meeting that all members are
uted in your area, then they may in Canpro’s member newsletter invited and encouraged to
refuse to set you up as a dealer. which is the heart of the Canpro attend. This meeting gives a
website.
review of the year, and gets input
Q. How do I place my orders? Q. How does Canpro Communi- from members on what new supAll normal orders are placed cate with its members? Canpro pliers should be contacted etc.
directly with the supplier , and keeps in contact with the mem- The meeting usually includes a
shipped directly to the members bership by regular updates to the table top trade show with 70+
location. (just like you do now). website, with new suppliers, new suppliers showing off the newest
There are no special purchase members, and special offers for and the best, with significant
orders required, nor is there any Canpro members. When new specials. This is an excellent
delay in processing your orders. information is posted to the web- networking meeting.
Q. Does Canpro do Group site, an e-mail is sent to all memBooking Orders?
Canpro bers. Members can also keep up Our 2014 meeting will be in
does a lot of group and booking to date with the Allpro programs Toronto on Oct 5 & 6th. Our
orders where it makes sense, by visiting the Allpro website meetings and trade shows are
open to members and approved
due to savings when buying that has weekly updates.
vendors only. Saturday will
in bulk, or to meet difficult pre- Q. Is Canpro Bilingual?
paid minimums, mostly from US With apologies, at the present have member workshops, with
Suppliers. Order forms are on time Canpro materials are avail- our meeting and tradeshow on
the Canpro members exclusive able only in English. Canpro Sunday.
website. Canpro will place the has only one paid staff member,
orders with the manufacturer for whom unfortunately does not Canpro reimburses our memshipment to the Canpro Distribu- speak or read french. Once bers to attend our annual meettion Centre where the orders will Canpro grows and additional ing and tradeshow usually one
be broken down and shipped (or staff members are required return airfare and one night hotel
picked up) to the participating being fluent in French will be a expense.
dealers.
requirement.
at the Distribution Centre? Yes.
Canpro stocks many of the products that are part of our group
orders, to back up the members that participate in our group
orders.
rebate program.
Q. Does ALLPRO
have meetings? Allpro has a Spring Sales
Meeting and Trade show, usually
held in Florida or the Western
US desert in March of each year.
Canpro Members are invited
to attend the ALLPRO Spring
Shows, which offers excellent
buying opportunities.
Q.. What happens to the annual
volume rebates from the Suppliers? Annual volume rebates
are a very significant advantage
of belonging to Canpro. Each
year over an average of over
$2000.00 has been rebated
back to each of our members.
Volume rebates from each supplier that offers volume rebates
are distributed by the members
that created the volume with
that supplier on a proportional
basis.
Some suppliers offer
two rebate programs, or growth
incentive programs one based
on the “Group purchases” and
one based on “individual members” purchases. All rebates are
passed directly on to the member
whom earned it.
Not all suppliers offer a volume
hidden rebates, term discounts
kickbacks. All term discounts,
Q. How and when are the or
trade discounts and central billrebates paid? Annual volume
ing discounts are passed directly
rebates are paid by credit note
onto the member on the face of
to the members early each year,
the Canpro invoice. Canpro’s
as soon as possible after the
books are available for review by
rebates have all been received
all members at our annual memfrom our suppliers (Normally in
bers meeting.
April or May).
Whom do I contact with my
Q. I already belong to another Q.
own questions?
buying group is this a problem?
For more information contact our
Canpro has a policy that memtreasurer Bob Pringle by phone
bers can not belong to another
at (780) 428-6690 or by fax (780)
buying group involved with paint
428-6691, or by e-mail informaor coatings. Buying groups of
[email protected] . Any
decorative products such was
member of the Canpro group
flooring, window coverings,
will also be glad to answer your
wallcoverings are not a probquestions.
lem. If the decorating products
buying group has common sup- Q.. Any other requirements? All
pliers, the member must inform members must be able to receive
the supplier which program he billings and communications by
wishes to be on, and stick with e-mail and should have internet
that decision for the balance of access to keep up to date with
the year. Rebates and discounts Canpro Programs.
from Canpro only apply to shipQ. How do I join?
ments that were billed through
The first step will be to fill out the
Canpro.
enclosed Prospective Members
Q. How does Canpro make Profile and fax it to the Canpro
money? Actually no where in our office.
You must also forward
mission statement, did we men- to the Chartered Accountant
tion making money! Our Goal is your most recent annual finanto ensure that our members save cial statements. (Address is on
money.
The group however the Profile page)
is able to break even with only
the membership fees, the .3% Once the report is received from
upcharge. Unlike some other the Accountant, the Canpro
building supply buying groups, office will then contact you and
Canpro does not solicit, nor will it complete the membership proaccept from any of our suppliers cess.
Thank you for your interest in the Canpro Buying Group.
We look forward to hearing from you soon.
For more information on please contact Bob Pringle, Managing Director
Canpro Decorating Products Inc.
10733-104 Avenue, Edmonton, Alberta Canada T5J 3K1
Phone (780) 428-6690 Fax (780) 428-6691
E-mail [email protected]
CANPRO 2014 ACTIVE VENDORS
Suppliers in Red Designate Private Label Suppliers
• denotes Canpro Warehouse stocked or group order lines
BR
RO U
LL SH
ER &
S
SP
CO EC
AT IA
IN LTY
GS
SU PA
PP IN
LI T
ER
S
PAINT SUPPLIERS
Benjamin Moore & Co Ltd.
Full line paint supplier
Coronado Paint
Full line paint supplier
INSL-X Products
Industrial & Specialty
Lenmar
Stains & Lacquers
International Paint / Devoe
Industrial Coatings
O`Leary Paint
Full line paint supplier
Para Paint (div. of General Paint)
Full line paint supplier
PPG Canada Inc. Full line Paint supplier
Sico Paints
Full line paint supplier
Pratt & Lamber Paints
Full line paint supplier
SPECIALTY COATING SUPPLIERS
Absolute Coatings
Specialty Coatings
Associated Paint
Strippable Coatings
Boomerang Paint
Recycled Paint
Cano Coatings
Fire Retardant Coatings
Chemcraft International Lacquers & stains
Consolidated Coatings
Specialty Coatings
Convenience Products
Specialty coatings
Deft Incorporated
Specialty wood finishes
Duckback Products Specialty Stains
Enviro Epoxy Products Inc.
Specialty Epoxy Coatings
Finitec Inc.
Floor Finishes
Flood Paint (see PPG)
Specialty Stains
Gaco Western
Roof & Deck Coatings
Krylon
Aerosol Paint Mad Dog Primer
Specialty Primers
Masterchem Industries Inc.
Kilz brand primers
Minwax
Stains and Wood Finishes
Modern Masters Inc. •
Specialty metallic Paints
Old Masters •
Stains and wood finishes
Rust-oleum Corporation
Industrial coatings
Saman
Specialty stains
Seymour of Sycamore Inc. •
Aerosol products
Sikkens Exterior Stains
The Sansin Corporation
Specialty wood finishes
Valspar Corporation
Cabots, Valspar
WoodPlus Coatings
Specialty Wood Finishes
XIM Products Inc.
Specialty Primers
BRUSH & ROLLER SUPPLIERS
Corona Brush •
Nour Trading House Inc
Pintar Manufacturing
Premier Roller •
Purdy
T.S. Simms
Wooster Brush Company •
Handcrafted brushes & rollers
Paint brushes and rollers
Paint brushes and rollers
Paint brushes and rollers
Handcrafted brushes & rollers
Paint Brush & Rollers
Paint Brush & Rollers
EQ SP
UI RA
PM Y
EN
T
PAINT SPRAY EQUIPMENT SUPPLIERS
Airlessco Spray Equipment •
ASM / Airlessco •
Coating Equipment Binks
Col-Met Spray Booths, Inc
Earlex Inc.
Graco Inc.
Mi-T-M Corporation
Paintline Products Inc
Pro-Tek
Titan SprayTech
Yorke Towne Supplies Ltd.
Airless Spray Equipment
Airless Sprayers & Accessories
Binks Spray Equipment
Spray Booth equipment
Consumer spray guns
Spray Equipment
Pressure Washers
Binks Spray Equipment
Body Shop Equipment
Spray Equipment
Spray Booth filters
SU SUN
PP D
LI RY
ER
S
SUNDRY SUPPLIERS
3M Canada Company
Abatron •
Ace Drop Cloth Co.
Advance Equipment Mfg •
Alliance Mercantile Inc.
American Paint Paddle
Bennett Tools & Hardware
Bercom •
Boss Manufacturing
Buckingham Stencils Inc.
Canadian Technical Tape
Chapin Manufacturing •
Color Putty Company Inc. •
Colour Testers
Copnick
Dap Canada Inc.
Degil Safety Products Inc.
Dentec Safety Specialists
DFP / Trade Secret
Dickies Canada •
Dripless, Inc. •
Dumond Chemicals
Dynamic
Eclectic Products, Inc.
Foam Pro Mfg. Inc. •
Full Circle International •
Frost King •
GH International
Homax Products Inc •
Intertape Polymer Group
Jen Manufacturing •
Klingspor Inc.
Kovrd •
Leaktite Corporation
Les Industries Gotham
Magnolia Brush
Martin & Associes •
Metaltech-Omega Inc.
Michigan Ladder Company
Momentive Performance •
Mumby & Associates
Natural Sea Sponges
Respirators, Sandpaper,
Wood & Concrete repair
Drop Cloths, Garments
Hand Tools
Gloves
Paint mixing Sticks
Tools & Hardware
HANDy Paint Pails
Gloves Decorative Stencils
Tape Products
Tank sprayers
Wood Filler
Paint Samples
Wipers (Quebec)
Caulks and repair products
Safety Products
Safety products
Furniture touch up materials
Garments
Caulking guns
Paint removers and graffiti
Full Line Sundry Distributor
Wood fillers and adhesives
Specialty foam rollers
Drywall sanding equipment
Allpro Branded Plastic Sheeting
Shurstik adhesives
Specialty Products
Tape Products
Foam Brushes & Rollers
Abraisive Products
3 in 1 Paint tray cover
Plastic Pails Paint Thinners & Solvents
Specialty Brushes
Sundry Distributor
Scaffold and ladder products
Scaffold and ladder products
Caulks and Sealants
Sundry Distributor
Sponges
SU SUN
PP D
LI RY
ER
S
W
SU ALL
PP PA
LI PE
ER R
S
TR WI
EA N
TM DO
EN W
TS
Newborn Brothers Norton (see St Gobain)
Olfa (see World Kitchen)
Ontario Wiping Cloth
Petowski Plastics •
Picquic Tool Co. Inc. •
Primex Abraisives Canada
Pro Vision Tools
Ralston Canada Inc.
Recochem (BC) Inc.
Red Devil Incorporated •
Richard Tools Roman Adhesives Inc. •
Seymour Mfg. Co. Inc. •
Sheffield Bronze Paint Corp
Shurtape Simtec Co. •
Sonin •
Supplierpipeline inc.
Surface Shields, Inc.
Swing Paints Limited
Thamesville Metal Products •
The Dillon Group
Toolway Industries Ltd.
Trimaco, LLC •
Ralston (Canada) inc.
Warner Tools •
YHD Distributors Inc
Zip Wall LLC •
Caulking guns
Sandpaper & Abrasive Products
Knifes and Blades
Wipers & Drop Sheets
Painter Plastic
Screwdrivers
Sandpaper products
Specialty tool
Plastic Sheeting
Paint Thinners
Caulks and Sealants
Hand Tools, Paint Applicator
Wallcovering Adhesives
Structron Extension Poles
Specialty Paint products
Tape products
Furniture Slides
Moisture Meters
Ladders and Equipment
Protective masking films
Circa Products
Bulldog Steel Wool
Draw Down Cards
Sundry Distributor
Masking products, drop cloths, W.
Plastic Sheeting
Hand Tools, Bull Dog Lighting
Sundry Distributor
Barrier Wall
WALLCOVERING SUPPLIERS
Blue Mountain Wallcoverings
Wallcoverings
Ontario Wallcoverings
Wallcoverings
Crown Wallpaper
Wallcoverings & fabrics
Etch Art - Wallpaper for Window
Wallpaper for Windows
Provincial Wallpaper
Wallcovering
Wallies (Mccall Pattern)
Wallcovering cut outs
WINDOW TREATMENT SUPPLIERS
Maxxamar
Shade-O-Matic
Springs Window Fashions
Horizons Window Fashions
Window Blinds & Shade
Window Treatments
Window Blinds Window Coverings
EQ
SU UI
PP PM
LI EN
ER T
S
BU
SU SI
PP NE
OR SS
T
STORE EQUIPMENT SUPPLIERS
CPS Color Equipment, Inc
Data Color
Fluid Management Canada
Hero Industries
Red Devil Equipment Co.
X-Rite
Paint Tinting equipment
Colour Matching Systems
Tinting Equipment Mixers
Paint tinting & mixers
Paint mixers
Colour Matching Systems
BUSINESS SUPPORT SUPPLIES
Addison Leasing
Car and Truck Leasing
Bigeye Productions
Web Publications & Signage
CBC Computer Systems
Computer Software
Centurion, Inc •
Labels and Stationary items
Graphica T-Shirts
Tee Shirts
Brand RPM
Garment & Specialty
Russell A Farrow Ltd.
Custom Brokerage Services
Tiger Courier Inc.
Courier Services
Canpro Decorating Products Inc.
Participants Application / Profile
Please Complete and return this profile to:
Canpro Decorating Products
10733-104 Avenue , Edmonton, Alberta, T5J 3K1
Phone (780) 428-6690 Fax (780) 428-6691
Legal Name________________________________________________ Phone__________________
Street Address______________________________________________ Fax Nbr _________________
Mailing Address_________________________City________________________ Prov. ___________
Postal Code______________________ e mail address ______________________________________
Business Type
[ ] Corporation, [ ] Partnership, [ ] Proprietorship
Date of incorporation if applicable _____________ website www.______________________________
GST Registration Number _________________________Prov. Sales Tax Nbr____________________
Primary Bank _____________________________________ Branch address_____________________
Company officers
(name, title and home Phone number)
Name___________________________________title______________ Cell. Phone_________________
Name___________________________________title______________ Cell Phone_________________
Name___________________________________title______________ Cell Phone_________________
Primary Contact Persons:
Principal Contact __________________________________ E-Mail _____________________________
Alternate Contact __________________________________ E-Mail_____________________________
Accounts Payable Manager _________________________________ Phone______________________
Invoicing e-mail address ________________________________________________________________
Main Branch Shipping Address;
Location____________________________________________________________________________
Name of Store_______________________________________________________________________
Address ___________________________________________________________________________
City___________________________ Prov.________________ Postal Code ____________________
Phone (______) _______-____________
Fax (_________) ________- ____________
Branch Manger _____________________________
Additional Shipping Locations (Directly owned branch stores):
Location____________________________________________________________________________
Name of Store_______________________________________________________________________
Address ___________________________________________________________________________
City___________________________ Prov.________________ Postal Code ____________________
Phone (_______) ______-____________
Fax (_________) ________- ____________
Branch Manger _____________________________
Location____________________________________________________________________________
Name of Store_______________________________________________________________________
Address ___________________________________________________________________________
City___________________________ Prov.________________ Postal Code ____________________
Phone (_______) ______-____________
Fax (_________) ________- ____________
Branch Manger _____________________________
Location____________________________________________________________________________
Name of Store_______________________________________________________________________
Address ___________________________________________________________________________
City___________________________ Prov.________________ Postal Code ____________________
Phone (_______) ______-____________
Fax (_________) ________- ____________
Branch Manger _____________________________
I agree to supply, under separate cover the most recent Corporation financial statement to:
Mr. Bruce Martyn, CA,
MD&P Chartered Accountants,
Suite 200, 4230 Sherwoodtowne Blvd.,
Mississauga, Ontario. L4A 2G6.
(Phone 1-905-279-7500 or Fax (905) 279-9300) e-mail [email protected]
All information contained in the financial statement is strictly confidential, that no member of Canpro,
including it’s officers or directors will have access to this information.
I understand the payment terms, and find the terms of participation and payment terms satisfactory.
Applicants Signature: _______________________________________Dated this _________________