Apply for Credit

 

Company Name:

Mailing Address:

Street Address:

City:

Province/State:

Postal/Zip Code:

Contact Name:

Phone:

Fax:

H.S.T. / G.S.T. No.:

P.S.T. Exempt No.:

Type of Business:

Amount of Credit Requested:  $

Business Type:

Date Incorporated:


Banking Information

 

Bank:

Address:

Bank Representative:

Telephone:


Trucking References (minimum of 3 required)

1. Name:

   Telephone:

   Fax:

2. Name:

   Telephone:

   Fax:

3. Name:

   Telephone:

   Fax:

 

 

I understand that AYR Motor Express Inc. terms are as follows, and I agree to comply with same: (1) All payment terms are fifteen (15) days from invoice date; (2) In case any question as to condition, loss, shortage of goods, or any other matter, bill shall be paid as rendered and claims presented for same; (3) Any unpaid balance will be subject to a service charge of 2% per month (24% per annum); (4) Payments will be applied first to service/finance charges and secondly to the unpaid balance of the purchase price; (5) This agreement and its covenants, provisions and conditions and stipulations shall ensure to the benefit of and be binding upon the respective heirs, executors, administrators, successors and assigns of the parties hereto; (6) Failure to pay bills as prescribed by the foregoing shall be considered sufficient cause for cancellation of the credit privilege. THE UNDERSIGNED ACCEPTS AS NOTICE IN WRITING OF ANY CONSENTS TO THE OBTAINING FROM ANY CREDIT REPORTING AGENCY OR ANY PERSON SUCH INFORMATION AS AYR MOTOR EXPRESS INC. MAY REQUIRE AT ANY TIME IN CONNECTION WITH THE CREDIT HEREBY APPLIED FOR AND CONSENTS TO THE DISCLOSURE OF ANY INFORMATION CONCERNING THE UNDERSIGNED TO ANY CREDIT REPORTING AGENCY OR TO ANY PERSON WITH WHOM THE UNDERSIGNED HAS OR MAY HAVE FINANCIAL RELATIONS. THE UNDERSIGNED HEREBY APPLIES TO AYR MOTOR EXPRESS INC. FOR A CREDIT ACCOUNT TO BE GRANTED ON THE TERMS AND SUBJECT TO THE CONDITIONS SET OUT HEREIN AND WARRENTS THAT THE INFORMATION SHOWN HEREIN IS TRUE AND THAT THE INFORMATION GIVEN IS FOR THE PURPOSE OF OBTAINING SERVICES AND MATERIALS ON CREDIT.

 

 

Authorized by:

E-mail:

Date: