COMMERCIAL CREDIT APPLICATION

COMPANY PROFILE

COMPANY NAME
HEAD OFFICE ADDRESS
CITY
PROVINCE
POSTAL CODE
TAX JURISDICTION / PROVINCE
TELEPHONE (WITH AREA CODE)
FAX (WITH AREA CODE)
E-MAIL ADDRESS
DESCRIPTION OF BUSINESS
LISTED WITH DUN & BRADSTREET?
DUNS #
INCORPORATION DATE
# OF EMPLOYEES
BUSINESS STRUCTURE
DIVISION/SUBSIDIARY? (Y/N)
IF YES, NAME OF PARENT COMPANY

EQUIPMENT INFORMATION

TYPE / DESCRIPTION
PURCHASE PRICE (PRE-TAX)
VENDOR NAME
DOWN PAYMENT
NEW OR USED
AMOUNT TO BE FINANCED
LEASE TERM (MONTHS)

OFFICERS/DIRECTORS

NAME TITLE FULL ADDRESS % OF OWNERSHIP

BANK REFERENCES

BANK NAME
BRANCH ADDRESS
TELEPHONE & AREA CODE
ACCOUNT MANAGER
BANK ACCOUNT NO.
# OF YEARS WITH BANK

TRADE REFERENCES

(TRADE REFERENCES OF PREVIOUS VEHICLE LESSORS REQUIRED)
FIRM NAME CONTACT NAME CONTACT PHONE # ACCOUNT OPENED HIGH CREDIT BALANCE

FINANCIAL STATEMENTS: FINANCIAL STATEMENTS AND ARTICLES OF INCORPORATION FOR THE PREVIOUS TWO YEARS WILL BE REQUIRED.

CONSENT TO COLLECTION, USE AND DISCLOSURE OF PERSONAL INFORMATION

By submitting this form, I/We consent to the collection, maintaining, updating, use and disclosure of personal information for the purposes of credit adjudication by the Lessor, affiliates, agents, funders and with any credit reporting agency, credit bureau, individual or corporation with whom you have financial dealings to enable the Lessor and its assignees to provide leasing services. I/We certify that the information contained in this Application is true, complete and correct.