BUSINESS CREDIT APPLICATION

APPLICATION FOR CREDIT PRIVILEGES
Box 100 262 Main St. Niverville. Mb. ROA 1E0 Niverville Phone: 204-388-4727

Fax: 204-388-4171 www.wmdyck.com
Business Info
Business Name*
Name*

FirstLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Email*
example@example.com
Banking Info
Banking Institution*
Phone*
Address*
Contact Name*
Credit Limit Required*
Invoices & Statements

Please select how you would like to receive your invoices and statements. Provide your email address to receive them digitally or select mail to receive them via Canada Post.
Please Email Invoices to:
example@example.com
Mail Invoices

Yes - Please send to my personal address above
Please Email Statements to:
example@example.com
Mail Statements

Yes - Please send to my personal address above
Do you Require POs (purchase orders)?*

YesNo
Business Info
Select your business type*

CorporationPartnershipProprietorshipNon-profit
Years in Business*
Name(s) of partners/principals/officers
Name(s) of authorized people who can charge on the account*
Provincial Sales Tax Number (if you wish to be PST exempt)
Trade References
Reference #1 Name

First NameLast Name
Reference #1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #1 Phone Number
Please enter a valid phone number.
Reference #2 Name

First NameLast Name
Reference #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #2 Phone Number
Please enter a valid phone number.
Reference #3 Name

First NameLast Name
Reference #3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #3 Phone Number
Please enter a valid phone number.
Comments
Please include notes or additional details here
Guarantee to WM. Dyck & Sons (1993)
I, First Name* Last Name* am accepting person liability for, and I will guarantee payment of, all purchases made and charged to the company account called Company Name of Guarantor* at Wm Dyck & Sons (1993).

This guarantee will remain in effect until I notify Wm Dyck & Sons (1993) in writing that I am terminating my guarantee. At the time of notification, I will guarantee and remai nliable for any purchases made on this company account up to the time of notification.
Dated at*
Location (city/town)
On this Day*

MonthDayYear
Date
Name of Guarantor*

First NameLast Name
Address of Guarantor*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date of Guarantor*

MonthDayYear
Date
Guarantor Signature*

Clear
WM. DYCK & SONS (1993) TERMS AND CONDITIONS OF CREDIT
I/we hereby make application for a credit account and in making this application agree to abide by the terms of credit as set out in your credit plan at this date or as it may be amended by you from time to time. It is understood that I/we will be notified in advance of any changes in terms, at least thirty days before such changes become effective. I/wee agree as follows:

1. To accept full responsibility for payment for all goods and services purchased by me or by others authorized to make purchases on my behalf or to use my charge account,

2.To so control purchases of goods and services by those authorized to purchase that the maximum accommodation extended will not be exceeded. This undertaking does not in any way limit my/our responsibility for goods purchased that may exceed this limitation.

3. To abide by such regulatory procedures as you may establish from time to time to control purchases within the limits arranged.

4. To make such payments as are required to keep the account in a current condition at all times.

5. To pay the amount due for each month's goods and services by the 15th of the month following that in which the purchases were made, unless I/we have requested and have had approved by you a schedule of deferred of extended payments (commonly referred to as revolving credit) and to keep current any such extension of payments.

6.ON ANY AMOUNT THAT IS NOT PAID BY THE 15TH OF THE MONTH I/WE AGREE TO PAY A SERVICE CHARGE OF 1.6% PER MONTH (20.983% COMPOUNDED ANNUALLY), CALCULATED MONTHLY AND ADDED TO THE ACCOUNT, UNTIL THE ACCOUNT HAS BEEN PAID IN FULL OR MADE CURRENT WITHIN THE TERMS ARRANGED.

7.ANY PAYMENTS MADE ON THIS ACCOUNT WHICH DO NOT PAY THE ACCOUNT IN FULL WILL BE APPLIED FIRSTLY TO PAY SERVICE CHARGES AND SECONDLY APPLIED ON THE PRINCIPAL OUTSTANDING.

8. To pay any and all costs that may be involved in the collection of any past due portion of any balance owing.

9. That the information supplied in this application is to be considered the basis of your assessment of my/our credit worthiness and that all such information is true and factual.

10.That my credit accommodation afforded under this application shall inure to the benefit of and be binding upon the respective executors, administrators, successors and assigns of the parties hereto.

11. I/WE CONSENT TO YOUR MAKING WHATEVER INVESTIGATION, OR OBTAINING WHATEVER REPORTS, YOU DEEM NECESSARY AT THIS DATE AND DURING THE TERM OF THIS AGREEMENT.

12.That this information may be passed on to a bank or other credit reference that I/we have supplied in order to verify my/our consent to obtain information from them regarding my credit worthiness.

13.ACCEPTABLE FORMS OF PAYMENT ON CHARGE ACCOUNTS ARE : DEBIT CARD, CASH, PERSONAL CHEQUE. CREDIT CARDS ARE NOT ACCEPTED TO PAY CHARGED AMOUNTS.
I/we hereby certify that I/we have read the terms and conditions on this application and agree to abide by them.
Dated at*
Location (city/town)
On this Day*

MonthDayYear
Date
Applicant Name*

First NameLast Name
Applicant Signature*

Clear
WM. DYCK & SONS (1993) PRIVACY POLICY
Personal information collected on this credit application and during the course of our business dealings with you are to be used for the following purposes only:
- To make an initial determination as to whether we wish to extend credit
- To make a determination at any point in our dealings as to whether we wish to continue extending credit
- To seek ways to recover monies owed to us should you fail to voluntarily pay them
- Personal information will not be passed on to third parties without your consent. Should you give our name as a credit reference to another party. we will deem you to have given consent to pass on information.
- Reasonable steps will be taken to ensure that personal information we have in our possession is protected.
Should be Empty:

APPLICATION FOR CREDIT PRIVILEGES

Business Info

Banking Info

Invoices & Statements

Business Info

Trade References

Comments

Guarantee to WM. Dyck & Sons (1993)

WM. DYCK & SONS (1993) TERMS AND CONDITIONS OF CREDIT

WM. DYCK & SONS (1993) PRIVACY POLICY