Credit Application Form « Locations PMC Capital inc.

Credit Application Form

CREDIT APPLICATION

General Information
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Company's lega Name*
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Trade Name*
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Email*
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Address*
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City*
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Province*
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Postal Code*
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Contact*
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Phone*
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Fax*
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Mobile*
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Type of Business*
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Number of Employees*
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Years in Business*
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Years of Experience*
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Bank Information
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Bank Name*
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Address*
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Account Number*
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Line of Credit / Limit $*
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Contact*
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Phone Number*
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Equipment Description
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Equipment Type*
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Make*
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Model*
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Years*
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Equipment Description*
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Vendor Name*
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Address*
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Contact*
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Phone Number*
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Lease Detail
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Equipment Cost*
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Cash / Exchange*
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Term Asked*
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Actionnaire Principal / Propriétaire
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Last Name*
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First Name*
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Social Insurance No*
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Date of birth*JJ/MM/AAA
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Personnal phone number*
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Address*
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City*
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Province*
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Postal Code*
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Owner*
Oui
Non
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If Yes / Value $*
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Mortage balance*
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Have you ever declared bankruptcy?*If yes, details
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Do you have a judgment which prosecution against you?*If yes, details
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I have read, understand and agree to the following terms and conditions*
By checking this box, the undersigned and/or guarantor certifies the above information to be true and correct. Bye signing below, I consent and authorize Locations PMC Capital Inc and its representatives and other affiliation to obtain, verify, use, communicate whit, any credit report agency or financial institution and obtain or disclose any information of personnel or financial nature relating to the analysis of the quality of my credit.
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