WEEKLY CREDIT APPLICATION

WEEKLY CREDIT APPLICATION
APPLICANT INFORMATION
Legal Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone*
Please enter a valid phone number.
Cell*
Please enter a valid phone number.
Email*
example@example.com
Manager's Name
Manager's Phone
Please enter a valid phone number.
Manager's Email
example@example.com
Owner's Name
Owner's Phone
Please enter a valid phone number.
Owner's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Business*

CorporationProprietorship
Number of Years in Business*
Credit Limit Requested*
G.S.T. Number*
P.O. Number Required?

YesNo
Accounts Payable Contact Name*
Accounts Payable Contact Email*
example@example.com
Statement Delivery Email*
example@example.com
If "Vehicle Repairs," please specify:
How many service bays do you have?
How many full-time employees do you have?
If "Fleet Maintenance," please specify:
How many vehicles are in your inventory?
Please choose one location as your primary contact:*

Auto Value Barlow SE - #155 3953 112 Ave SEAuto Value Country Hills - 170 11358 Barlow Trail NEAuto Value Crowfoot - #4 250 Crowfoot Crescent NWAuto Value Forest Lawn - 5140 Hubalta Road SEAuto Value Macleod Trail - #123 8228 Macleod Trail SEAuto Value Midnapore - 5150 Bannister Road SEAuto Value 16th Ave - 616 16 Ave NWAuto Value 17th Ave SW - 3821B 17 Ave SWAuto Value 32nd Ave NE - 1633 32 Ave NECentral Auto Parts Distributors (Main Warehouse) - 34 Highfield Circle SEAuto Value Airdrie - #103 1300 Market StreetAuto Value Drumheller - 300 South Railway Ave EAuto Value Lethbridge - 1707 3 Ave SAuto Value Red Deer - 6870 Gaetz Ave
This account is a CREDIT CARD SECURED CHARGE ACCOUNT:
Credit Card information (Optional)

You will receive a call from our accounting department at 403-259-8658 to confirm your card number
Credit Card Number
Expiry Month
Expiry Year
CVC
Name of Card Holder
Weekly Account Terms & Conditions:
- I agree to maintain an active credit card on file with sufficient funds for payment.
- I agree to provide updated credit card information to Central Auto Parts Distributors Ltd. promptly when required.
- Accepted payment methods are credit card (preferred), cheque, e-transfer, cash, or EFT.
- A $1.00 fee per document applies for each duplicate statement, invoice, credit note, or record of account (ROA) requested.
- Past due balances will be subject to a late fee of 2% per month (24% per year).
- Declined payments or failure to update credit card information will result in the account being placed on stop.
- Accounts with no activity for 24 months will be closed.
- I acknowledge that payments will be processed automatically without prior notification or approval.
- Central Auto Parts Distributors Ltd. may update these terms at any time, without notice. Continued use of services implies acceptance of updated terms.
I certify that the information provided in this application is accurate and submitted for the purpose of obtaining goods on credit. I authorize Central Auto Parts Distributors Ltd., or its representatives, to contact the listed references regarding my credit history and financial standing. I authorize Central Auto Parts Distributors Ltd., or its representatives, to charge the credit card listed for the weekly outstanding balance on my account.
Signature*
First and Last Name*
Title*
Signing officer of the company
Date*

MonthDayYear
Date
Please verify that you are human*
INTERNAL USE
Account Number
Set-up Date

MonthDayYear
Credit Limit
Approved By
Special Pricing
Sales Representative
Account Approved By
Date Approved

MonthDayYear
Should be Empty:

WEEKLY CREDIT APPLICATION

APPLICANT INFORMATION

Credit Card information (Optional)

INTERNAL USE