Please fill in this form entirely before submitting.
Legal Name of Business: Date Business Established: Trade Name (if any): Type of Business: Corporation Partnership Sole Owner Is Company a subsidiary of another company? Yes No Please provide the following contact information:
Estimated Annual Purchases: Principle Owner's Name & Title: Home Address: S.I.N. - required for identification purposes: Partner/Other Officer's Name & Title: Home Address of Partner/Other: S.I.N. - For Partner/Other:
If in business less then 2 years, please provide name of former employer:
Individual to contact re: Payments:
Credit line you are requesting (Financial statements are required for credit lines over $50,000:
Banking Information Bank: Branch: Acct.#:
Please list 3 major credit references where credit currently is extended (provide name, address, telephone number and contact for each)
Type of account you wish to be open: Fuel - Delivered Kardgard Fuel * How Many Gas 0 1 2 3 4 5 6 7 8 9 10 How Many Diesel 0 1 2 3 4 5 6 7 8 9 10 How Many Both 0 1 2 3 4 5 6 7 8 9 10 Ready Mix Aggregates Asphalt
Your Sales Representative: Bill Fligg Walter Marshall Doug Sutton John Mannerow Dale Dennis Scott Elliott Rob Fyles John Rumble Terms and Conditions: 1. This is an Application and Agreement for credit and shall apply to any and all credit extended by The Sarjeant Co. Ltd. 2. Applicant has authority to enter this agreement. Person signing has been authorized to execute this agreement for applicant. 3. The information given is warranted to be true and given for the purpose of obtaining credit. The applicant consents to the obtaining of credit and/or personal information as may be required in connection with the credit line hereby applied for or any renewal or extension thereof and to the disclosure of any trade information concerning the undersigned to any credit reporting agency or to any person with whom the undersigned has or proposes to have financial relations. 4. In the event credit privileges are extended, I/we agree to abide by the terms of sale of The Sarjeant Co. Ltd. and conditions. 5. I/we agree to pay interest charges on overdue accounts at the rate of 2% per month, 24% per annum, as shown on your Invoice/Statements. 6. NSF cheques will be subject to a $15.00 charge. 7. The undersigned hereby agrees to pay all accounts when rendered. On default, the undersigned agrees that all lawyer's and/or agent's costs of recovering the debt are also payable. 8. Failure to comply with these Terms and Conditions may result in cancellation of credit privileges. DO YOU AGREE WITH THE ABOVE TERMS AND CONDITIONS? Type "yes" to agree or this form will not be submitted (all lowercase)! Thank You
Terms and Conditions:
1. This is an Application and Agreement for credit and shall apply to any and all credit extended by The Sarjeant Co. Ltd.
2. Applicant has authority to enter this agreement. Person signing has been authorized to execute this agreement for applicant.
3. The information given is warranted to be true and given for the purpose of obtaining credit. The applicant consents to the obtaining of credit and/or personal information as may be required in connection with the credit line hereby applied for or any renewal or extension thereof and to the disclosure of any trade information concerning the undersigned to any credit reporting agency or to any person with whom the undersigned has or proposes to have financial relations.
4. In the event credit privileges are extended, I/we agree to abide by the terms of sale of The Sarjeant Co. Ltd. and conditions.
5. I/we agree to pay interest charges on overdue accounts at the rate of 2% per month, 24% per annum, as shown on your Invoice/Statements.
6. NSF cheques will be subject to a $15.00 charge.
7. The undersigned hereby agrees to pay all accounts when rendered. On default, the undersigned agrees that all lawyer's and/or agent's costs of recovering the debt are also payable.
8. Failure to comply with these Terms and Conditions may result in cancellation of credit privileges.
DO YOU AGREE WITH THE ABOVE TERMS AND CONDITIONS? Type "yes" to agree or this form will not be submitted (all lowercase)! Thank You
Print and fax to: (705) 728-8643, if you do not wish to send this information via email.
____________________________________________________ Authorized Signature: I agree to the terms and conditions listed above.