Credit application

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 PRESVAC. 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 PRESVAC 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
Enter todays date: 2008-7-19 - - We need to ask you this, to prevent spam-bots from flooding our Dealers in-boxes. Please use the exact yyyy-mm-dd format.