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Credit Application
| Company Information as Applicable |
| Legal Name |
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Corporation # |
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| Trade Name |
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Phone |
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| Address |
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Fax |
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| City |
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Postal Code |
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| Prov |
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| Contact |
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Position |
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| Type of Business |
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Years in Business |
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| Contact |
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| Insurance broker |
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Telephone |
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| Owner / Partner / Personal Information as Applicable |
| Name |
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Phone |
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| Address |
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Cell |
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| City |
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Postal Code |
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| Prov |
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| Occupation |
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Employer |
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| SIN |
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How long employed |
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| Date of Birth |
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Gross monthly income |
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| Banking Information |
| Bank |
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Contact Name |
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| Address |
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Postal Code |
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| Account number |
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Prov |
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| Phone |
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Fax |
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| Trade References |
| Company |
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Address |
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| Contact |
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Fax |
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Phone |
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| Company |
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Address |
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| Contact |
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Fax |
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Phone |
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| Company |
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Address |
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| Contact |
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Fax |
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Phone |
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| Other Information |
| PST exemption # |
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GST exemption # |
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| A/P contact |
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Telephone |
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| Reason for seeking credit |
Rental Parts Service Equipment Lease Other |
| Purchase order required |
Yes No |
| Amount of credit requested |
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| You confirm that the information you have given us in respect of this application is true and complete, and you authorize us to rely on and use this information in order to confirm your identitiy, evaluate your credit worthiness, in relation to the credit being sought.In particular, you agree that we, our affiliates and any third parties acting for us or on our behalf (hereinafter collectively "us", "we" or "our"), may obtain a credit report or other credit information from any credit reporting agency, credit bureau or credit grantor, and may hold, use, exchange and disclose such information for the purposes of transacting business with .If your application is approved, you authorize us to collect , hold use, exchange anddisclose your personal information, as required, in order to administer, service or enforce any lease, ancillary deed or transaction including but not limited to assignments and securitizations.We will keep a file containing some or all of your personal information at the offices ofYou have the general right to access and rectify the personal information in this file by making a written request to our offices.Terms Net in 30 days,accounts overdue may have a S/C applied and may be placed on credit hold.If there is a defaultcollection fees will be the responsiblility of the customer. |
| Position |
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Print Name |
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| Date |
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