306-955-5955

Credit Application

Company Information as Applicable
Legal Name Corporation #
Trade Name  Phone
Address Fax
City Prov Postal Code
Contact Position
Type of Business Years in Business
Insurance broker Contact Telephone
Owner / Partner / Personal Information as Applicable
Name Phone
Address Cell
City Prov Postal Code
Occupation Employer
SIN How long employed
Date of Birth Gross monthly income
Banking Information
Bank Contact Name
Address Prov Postal Code
Account number Phone Fax
Trade References
Company Address
Contact Phone Fax
 
Company Address
Contact Phone Fax
 
Company Address
Contact Phone Fax
Other Information
PST exemption # GST exemption #
A/P contact Telephone
Reason for seeking credit Rental Parts Service Equipment Lease Other
Purchase order required Yes No Amount of credit requested
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 and  disclose 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 of   You 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 default  collection fees will be the responsiblility of the customer.
Position Print Name Date

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