Harrigan Rentals - Credit Application

Date:
Legal Name of Applicant:

Street Address:		City:
Province:		Postal Code:
Phone Number:		Fax Number:
Cell/Mobile:

CONTACTS

Buyer #1 Name:		Telephone:	Fax:
Buyer #2 Name:		Telephone:	Fax:
Buyer #3 Name:		Telephone:	Fax:
A/P Person:		Telephone:	Fax:
Email Address:

Applicant Information

Is your business a:	Company/Ltd/Corporation/LLC: Proprietorship/Partnership:

Type of Business:

Year Incorporated:		Years in Business:
Principal Name #1:		Title:
Home Address:		Home Phone Number:
Principal Name #2:		Title:
Home Address:		Home Phone Number:

Name of Partners:		Address:
		Address:

Years in Business:		No. of Employees:
Business License #:		Annual Sales:
Do you own your building? Yes No		HST Number:
	Rent? Lease?	Landlords Name:
Address:		Telephone Number:


Bank
Name of Bank:
Address:		Telephone Number:
Name on Bank Account:

Other
If account is for a single site please supply site address, phone & fax #'s
Site Address:
Telephone Number:		Fax Number:

SUPPLIER REFERENCES (3)

Supplier Name	Telephone Number:	Fax Number
Supplier Name	Telephone Number:	Fax Number
Supplier Name	Telephone Number:	Fax Number

Credit Policy

I/We the undersigned agree topay within the terms stipulated on each invoice. I/We the undersigned hereby authorize Harrigan Rentals & Equipment Ltd. or it's agents to obtain credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of an account of for any other direct business reason. If any account becomes in arrears and collection process becomes necessary, all amounts owing on the account become due in full and terms no longer apply. Any amonts over 30 days outstanding shall bve subject to interest charges of 2% per month (26.82% per annum). Harrigan Rentals & Equipment Ltd. reserves the right to revoke credit priviledges and close an existing account without notice. Amounts becoming in arrears and/or requiring third party collection processes invalidate any prior terms and/or agreements and all amounts owing become immediately due for payment in full.
I/We the undersigned have read and understand your terms of credit as indicated above and agree to abide by them. I/We the undersigned also understand and confirm that I/We are PERSONALLY RESPONSIBLE and PERSONALLY LIABLE, jointly and severally for payment of all goods and services supplied by or on behalf of Harrigan Rentals & Equipment Ltd.

BUSINESS NAME:

Principal's Name:	Signature:	______________________________________________________
Title:	Date:

Principal's Name:	Signature:	______________________________________________________
Title:	Date:

OFFICE USE ONLY

ACCT #:	_______________	BRANCH:	____________________	Sales Rep:	________________________

Approved:	___________________________________			Date:	________________________