CORPORATE CREDIT APPLICATION SUPPLIER & TRANSACTION DETAILS Supplier/Dealer/Seller Name Supplier Email Area Code Phone Number Contact Person Equipment Description(Year, Make, Model etc) * Is this a Private Sale Yes No Equipment condition * New Used Purchase Price * Financing Request Trade-in/Downpayment($$) Lease Term requested * Help us to know you! Company Information Corporation Sole Proprietorship Partnership Other Choose Industry * Choose Industry Construction Transportation Forestry Manufacturing Medical/Dental Other Other Industry Legal Name of the Entity* Operating Name Same as Legal Name In Business Since * Number of Employees Company Registered Address * City * Province * Choose Province ON QC NS NB MB BC PE SK AB NL Postal Code * Equipment Location (when not in use) * Type of Contact * Home Work Mobile Area Code * Contact Number * Email Address * Business Website GST Number Are you PST exempt? Yes No Guarantor/Owner Details First Name Middle Last Name Date of Birth Social Insurance Number(optional) Address City Province Choose Province ON QC NS NB MB BC PE SK AB NL Postal Code Email Address Area Code Contact Number Second Guarantor Details First Name Middle Last Name Date of Birth Social Insurance Number(optional) Address City Province Choose Province ON QC NS NB MB BC PE SK AB NL Postal Code Email Address Area Code Contact Number I/We, the applicant, principal and/or guarantor each : acknowledge that providing a social insurance number is optional and not a condition to obtaining a credit review; consent to the collection, use and disclosure of personal information for the purposes of credit adjudication by the Lessor/Lender and its funders and to enable the Lessor/Lender and its assignees to provide financing and to promote the products and services of the Lessor/Lender and its affiliates; and consent to the Lessor/Lender and its funders obtaining information relating to the applicant, principal and/or guarantor from credit reporting agencies in connection with this application.
