Commercial Credit Application
Territory Manager
Applicant's Information
Legal Business Name
*
(hereinafter known as applicant)
Legal Status
*
Please Select
Sole Proprietorship
Partnership
Incorporated
Parent Company (if applicable)
How long has this company been in business?
*
Is your business exempt from paying sales tax and/or exempt from paying carbon tax exempt?
*
Please Select
Yes
No
Please provide your tax exempt number or confirmation as applicable
*
Please provide a copy of your exemption letter or certificate.
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How long have you operated this business?
*
Please Select
1 yr
2 yrs
3 yrs
4 yrs
5 yrs
6 yrs
7 yrs
8 yrs
9 yrs
10+ yrs
What industry do you operate within?
*
Please Select
Agriculture, forestry and fishing
Arts, sports and recreation
Catering and accommodation
Construction
Education
Health and social care services
IT and telecommunication services
Manufacturing
Media and creative services
Mining, energy and utilities
Personal services
Professional and business services
Retail, hire and repair
Wholesale
Automotive Repair
Trucking/Transportation
Mailing Address
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Email
*
example@example.com
Telephone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Number
Please enter a valid phone number.
Format: (000) 000-0000.
Accounts Payable
Contact Person
*
Telephone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Owner(s)/Officer(s)
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Are you a First Nations individual living on a reserve, and are exempt from paying sales taxes on personal property?
*
Please Select
Yes
No
Please provide your status card number
*
Please provide the copy of the front and back of the card which is required by the Government
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Choose a file
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Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Other Information
Do you require cards for cardlock services?
*
Please Select
Yes
No
If yes, how many?
How much credit do you think you will need/per month?
Do you own your own place of business or do you rent?
Please Select
Rent
Own
Landlord Name
First Name
Last Name
Landlord Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
If you are sole proprietor, do you own your place of residence or rent?
Please Select
Rent
Own
Who is your current fuel and/or lubricant supplier?
Trade References
Business Name
Type of Supplier
How long with them?
Please Select
1 yr
2 yrs
3 yrs
4 yrs
5 yrs
6 yrs
7 yrs
8 yrs
9 yrs
10+ yrs
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Contact
First Name
Last Name
Banking Information
Financial Institution
*
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How would you like to receive your monthly statement?
Please Select
Email
Mail
Submit Your Application
Please check
*
I have read and agree to the terms and conditions.
BEFORE SUBMITTING ANY INFORMATION TO US PLEASE READ, UNDERSTAND AND AGREE TO THE FOLLOWING TERMS AND CONDITIONS
The Applicant certifies that the above information is true and correct. By submitting this application electronically, the Applicant authorizes McDougall Energy Inc. or its agent to conduct credit history checks for the purposes of credit approval. The Applicant further agrees that this authorization is ongoing and to be used by McDougall Energy Inc. only when reasonably necessary for the purposes of monitoring the Applicant’s account and/or for debt collection. The Applicant further authorizes McDougall Energy Inc. or its agent to contact banking and trade references. McDougall Energy Inc. collects credit information for the purpose of credit approval, account monitoring and debt collection only. We do not distribute, sell or disclose any customer information without consent or unless required to do so by law. Our files are kept secure. Our privacy policy is available upon request. By submitting this application electronically, the Applicant agrees to keep their account current and in good standing. Interest in the amount of 2.5% per month shall be charged for all accounts past due. The Applicant further agrees that should collection proceedings or legal action be necessary to collect on the Applicant’s account, the Applicant agrees to be responsible for all costs incurred by McDougall Energy Inc. or their authorized agent, to collect payment.
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*
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