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Credit Application |
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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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Prov |
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Postal Code |
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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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| Insurance broker |
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Contact |
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Telephone |
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Owner / Partner / Personal Information as Applicable
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| 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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Prov |
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Postal Code |
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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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Prov |
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Postal Code |
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| Account number |
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Phone |
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Fax |
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Trade References |
| Company |
|
Address |
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| Contact |
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Phone |
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Fax |
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| |
| Company |
|
Address |
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| Contact |
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Phone |
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Fax |
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| |
| Company |
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Address |
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| Contact |
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Phone |
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Fax |
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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
Other
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| Purchase
order required |
Yes
No
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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 Dan Greer Enterprises Ltd..
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 Dan Greer Enterprises Ltd. 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.
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| Position |
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Print Name
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Date |
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| Email: |
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