Company Name or Individual

Address

City

Province/State

Postal/Zip Code

Telephone Numbers

Business

Fax

Residence

Length of Time in Business

Type of Business

Number of Diesel Units

Number in Fleet

Company Owner

Bank

Bank Address

Phone Number

Account Number

Fax Number

Transit Number

PST Exemption Number (if applicable)

Are P.O.'s Required?

Maximum Credit Required

Accounts Payable Contact

Do You Require Monthly Statements?

• I / We agree to pay invoices on a net 30 days basis.
• I / We understand a service charge of 1.5% per month (18% per annum) is applicable on overdue accounts.
• I / We understand that if the above terms and conditions are not met, the account may be placed on a C.O.D. basis without notification.
• I / We hereby certify that the information given above is both true and correct.
• I / We hereby consent to the obtaining of such information as Garry Mercer Trucking Inc. or their agents may require at any time in connection with this application and to the disclosure of any credit information concerning the individual/company to any credit or reporting agency or any person with whom the individual/company has, or proposes to have, financial relations.
• I / We have read and agree to comply with the above terms and conditions.