Requested Credit Amount: $ - Account Applicant

Date: ___________
Requested Credit Amount:
$_______________
Account Applicant:
Legal Name: _______________________________________________________________________________
Parent Trading Company (if any): ______________________________________________________________
DBA Name (if different): _____________________________________________________________________
Address: _____________________________________________________
Unit #: __________________
City, Province: ________________________________________________
Postal Code: ______________
Phone #: (____)_______________________________________________
Fax #: (____)______________
New Business: Yes

No
Years Established: ______________
Annual Sales: __________________
Number of Employees: __________
Homebuilder
Framer
Developer
Other (Specify): ___________
Nature of Business (check all that apply):

New Home Construction
Other (Specify): ______________
Business Type:
Commercial Building
Renovations
Principles/Directors/Officers Information:
Name
Title
Phone #
_________________________________________________________________(___)______________________
Address:__________________________________________________________SIN:_______________________
Name
Title
Phone #
_________________________________________________________________(___)______________________
Address:__________________________________________________________SIN:_______________________
Name of Purchasers:
Name
E-mail
Phone #
_________________________________________________________________(___)______________________
_________________________________________________________________(___)______________________
Accounts Payable Contact:
Name
E-mail
Phone #
_________________________________________________________________(___)______________________
Bank Information:
Bank Name:_____________________________________________ Phone #: (___)_______________________
Branch #:_____________ Contact: __________________________ Phone #: (___)_______________________
Local Trade References (3 Required):

Company Name
Phone #
Fax #
____________________________________(___)________________________(___)_____________________
____________________________________(___)________________________(___)_____________________
____________________________________(___)________________________(___)_____________________
Terms & Conditions:
Terms are net 30 days from date of purchase.

There are to be no deductions, holdbacks or offsets of any kind from the amount billed unless prior
authorization is obtained.
A service charge of 2% per month (24% per annum) is charged on all past due accounts.
Failure to comply with the above terms and conditions will result in cancellation of all credit privileges
with Cloverdale Concrete Form Rentals Ltd.
In the event of non-payment when demanded, Cloverdale Concrete Form Rentals Ltd. will use any legal
means at its disposal to collect the account without further notice. Costs associated with any collection
action taken are the responsibility of the applicant.
Cloverdale Concrete Form Rentals Ltd. reserves the right to obtain a personal guarantee before granting
credit.
In order to reinstate a C.O.D. account, payment must be made in full including service charges and a new
credit application must be processed.
I/we hereby represent that I/we are authorized to submit the application on behalf of the customer
named above. I/we hereby authorize the person or firm to whom this application is submitted to obtain
credit reports or other information as may be deemed necessary in connection with the establishment
and maintenance of a credit account or for any other direct business requirements. The undersigned
agrees to pay service charges on overdue accounts. It is also agreed and understood that all necessary
collection and legal and interest fees may be charged to my company in the event of default or failure to
pay for services rendered.
Title to all parts and equipment shall remain vested to Cloverdale Concrete Form Rentals Ltd. and nothing
contained in this document or any others shall be deemed to have the effect of transferring right or title
in any goods supplied until such time as the debt has been repaid in full and terms of sale have been
agreed upon by both parties. The Customer hereby grants to Cloverdale Concrete Form Rentals Ltd. a
security interest in any goods, parts and equipment purchased or rented by it, as security for the
obligation of the Customer to pay the purchase price and all other amounts owing to Cloverdale Concrete
Form Rentals Ltd.
I/We being the principal(s) of:______________________________________________________________
(complete legal name of company)
(hereinafter referred to as the Corporate Customer) acknowledge that I am/We are co-applicant(s) and
will be personally responsible jointly and severally with the Corporate Customer for any and all debts
incurred as a result of this application, whether or not the invoice is made out solely in the name of the
Corporate Customer. I/We will jointly and severally indemnify Cloverdale Concrete Form Rentals Ltd., and
shall pay your account for any order invoiced to the Corporate Customer.
I/We have read and agree to comply with the above terms & conditions. I/We hereby authorize Cloverdale
Concrete Form Rentals Ltd. to pursue a credit investigation pertaining to my and/or our company credit and
financial responsibility.
Applicant name (please print):
Signature:
Title:
________________________________________________________________________________
Owner/partner/corporate principles must sign
________________________________________________________________________________
Owner/partner/corporate principles must sign

Requested Credit Amount: $ - Account Applicant

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Requested Credit Amount: $ - Account Applicant

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Date: ___________

Requested Credit Amount:

City, Province: ________________________________________________

Postal Code: ______________

New Business: Yes

Nature of Business (check all that apply):

Local Trade References (3 Required):

Terms are net 30 days from date of purchase.

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