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PRODUCTS
CANADIAN MADE
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DOCUMENTATION
E-CATALOGUES
FULL LINE DIGITAL CATALOGUE
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CREDIT APPLICATION
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Can-Cell Industries Representative's Name
*
COMPANY INFORMATION
Client's Name
*
Business Name
*
Head Office Address
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City/Town
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Province
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Postal Code
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Company Exists Since
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Phone
*
E-mail Address
*
Fax
G.S.T. No / TIN
*
P.S.T. No / TIN (if applicable)
Tax Exemption No. (if applicable)
Credit Limit Requested According to the Forecasted Monthly Purchases (in $)
*
Person to Contact for Payment
*
Phone
*
E-Mail Address
*
Purchase Orders Required?
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Yes
No
Statements Required?
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Yes
No
Owner or Majority Shareholder
Name of Owner or Majority Shareholder
*
Date of Birth (MM/DD/YY)
*
Address
*
S.I.N. #
*
Phone
*
Investment Banking
Merchant Bank
Upload Company VOID Cheque (.png, .jpg, .pdf accepted)
*
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Choose Files to Upload
Primary Financial Institution
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Address
*
Phone
*
Fax
E-Mail Address
Account Manager
*
Account #
*
Transit #
*
Personnel Account #
*
Name of Financial Institution if Different from Primary
*
Exemption Name Phone
Commercial References
A minimum of (2) references is required
1. Name
*
First
Last
2. Name
*
First
Last
3. Name
First
Last
4. Name
First
Last
Phone
*
Phone
*
Phone
Phone
Fax / E-Mail Address
*
Fax / E-Mail Address
*
Fax / E-Mail Address
Fax / E-Mail Address
Terms and Conditions
Acceptance of Terms and Conditions
*
I have read and agree to the
Terms and Conditions
Customer Signature
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Clear Signature
Guarantor Signature
*
Clear Signature
Customer Name (PRINTED)
*
Guarantor Name (PRINTED)
*
Title
*
Title
*
Government Photo ID for Verification (Customer)
*
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Government Photo ID for Verification (Guarantor)
*
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Date
*
Suretyship and Personal Guarantee
The undersigned bind themselves personally and irrevocably as sureties of all of the CLIENT’s obligations past, present and future and guarantee their fulfillment as well as renouncing to the benefit of discussion of the CLIENT’s seizable property.
Guarantee Signature
*
Clear Signature
Guarantor Signature
*
Clear Signature
Guarantee Name (PRINTED)
*
Guarantor Name (PRINTED)
*
Title
*
Title
*
Date (MM/DD/YY)
*
MOVEABLE HYPOTHEC (Applicable and accepted if signed)
As an additional guarantee of the CLIENT’s obligations and to insure payment of amounts owed, including interest, judicial and extrajudicial fees and accessories, the CLIENT agrees to hypothec in favour of CAN-CELL INDUSTRIES INC., for the sum represented below, the universality of its products, inventory, merchandise and other similar goods, present and future, of its business, including without limitation, general merchandises as well as wrapping, warehousing and shipping supplies, and any goods acquired in replacement of the universality in whole or part, insurance indemnities in the event of loss or claim, and any money or other considerations resulting from the sale or alienation of the universality in whole or part. The CLIENT agrees and undertakes to sign any document or additional agreements necessary to carry out the creation and registration of the movable hypothec.
The CLIENT hypothecs in favour of CAN-CELL INDUSTRIES INC. for the sum of ($)
Signed in:
Date (DD/MM/YY)
Signature
Clear Signature
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