Credit Application for Easy Equipment Parts Financing

BILLING / SHIPPING INFORMATION

OFFICIAL COMPANY NAME^*

PRIMARY PHONE^*

PRIMARY FAX^*

PRIMARY EMAIL^*

BILL TO INFORMATION

ADDRESS LINE 1^*

CITY^*

PROVINCE/STATE^*

POSTAL CODE/ZIP^*

SHIP TO INFORMATION

Same as above

BUSINESS INFORMATION

TYPE OF LEGAL ENTITY^*

CORPORATION

PARTNERSHIP

PROPRIETORSHIP

SUBSIDIARY OF, OR DIVISION OF

D&B^*

YEARS IN OPERATION^*

NET WORTH

SALES PER YEAR^*

OFFICERS/OWNERS INFORMATION

Name (1)^*

TITLE (1)^*

EMAIL (1)^*

Name (2)

TITLE (2)

EMAIL (2)

Name (3)

TITLE (3)

EMAIL (3)

ACCOUNTS PAYABLE INFORMATION

AP CONTACT NAME^*

AP EMAIL^*

AP PHONE^*

UPLOAD FINANCIAL DOCUMENTS

Please provide us with copies of all tax exemption certificates.

Accepted file types: JPEG, PNG, PDF

Maximum upload size: 5MB

BANKING INFORMATION

BANK NAME^*

ACCOUNT #^*

CONTACT NAME^*

PHONE^*

ADDRESS LINE 1^*

CITY^*

PROVINCE/STATE^*

POSTAL CODE/ZIP^*

TRADE REFERENCES

REFERENCE 1^*

CONTACAT^*

PHONE^*

EMAIL^*

REFERENCE 2^*

CONTACAT^*

PHONE^*

EMAIL^*

REFERENCE 3^*

CONTACAT^*

PHONE^*

EMAIL^*

REFERENCE 4^*

CONTACAT^*

PHONE^*

EMAIL^*

CUSTOMER'S AUTHORIZATION TO RELEASE BANK AND TRADE INFORMATION

Attention Bank and Trade references: Please provide information on all accounts listed as well as any loan information. You will be servingour interest best if youare able to provide the information over the phone. Thank you.
I / We hereby authorize you to whom this application is made, or your agents, to investigate my / ourcredit worthiness andwill provide financial statements, taxreturns etc. as you deem necessary.

PREPARED BY (NAME)^*

TITLE^*

PREPARED BY (SIGNATURE)^*

DATE^*

Credit Application for Easy Equipment Parts Financing

BRANDS WE CARRY