Secure Credit Application

Business Contact Information
Legal Business Name: (the Customer) Trade Name: (if different from above)
Phone: Fax: Cell: Email:
Business Address:
City: Province: Postal Code:
Date business commenced:
Sole proprietorship:    
Partnership:    
Corporation:    
Other:    
       
Name of Primary Shareholder:    
       
Personal and Credit Information
Applicant's / Guarantor's Name: Applicant's / Guarantor's Address (if different from above)
 
City: Province: Postal Code:
How Long at Current Address?  
 
Owned? Renting?    
 
Info Required to Confirm Personal Credit:
Home Phone: Birth Date: SIN
Bank name: Bank address: Phone:
Account Number: PST Number: (if applicable)  
 
Visa: MC: Card Number Expiry Date:
 
     
Business/Trade References
Name: Contact:
Phone: Credit Limit:
Name: Contact:
Phone: Credit Limit:
       

Agreement

  1. I/We hereby authorize Western Concrete Products to investigate any references or statements herein contained in my/our application pertaining to my/our credit worthiness and financial responsibility, as reasonable to establish a credit account. Should a credit account be opened for me/us, I/We hereby guarantee to pay my/our credit account by the end of the month following the month in which I/We purchased the goods. I/We understand that, if payment in full is not received by Western Concrete Products by that date, interest will be charged on any unpaid balance, commencing on the first day of the month following the month in which I/WE purchased the goods, at a rate equal to 2.0% per month (24% per annum) and I/We agree to pay all such interest. In the event of my/our account becoming more than 60 days past due, I/WE authorize Western Concrete Products to charge the balance of my/our account to my/our credit card account provided above.
  2. IT IS AGREED that the undersigned is a Principal Debtor and not merely a surety and this covenant is joint and several with the covenant of the Customer, and if the undersigned is more than one person, then covenants shall be joint and several.
  3. In addition to all remedies available to Western Concrete Products, Western Concrete Products is free to pursue collection proceedings and/or former legal action against the Customer(s) and Guarantor(s) if any, and I/We hereby agree to be responsible for all costs incurred by Western Concrete Products in pursuing such collection proceedings and/or legal action, including all costs whether legal fees, disbursements or costs, all calculated as actually paid to a solicitor as rendered to his client basis. I/We understand that a credit account would not be extended to me/us without agreement to the above terms. I/We hereby declare that I/WE have read, understood, and agree to the terms and conditions of my/our application.