DRC Fleet Management Systems - Credit Application

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DRC Instruments
54 Martindale Drive NE
Calgary, AB T3J 2V4

DRC Instruments Commercial Credit Application


Date:
Client Information
Legal Business Name:		Phone:	( )
Address:		Date of Incorporation:
		Change of Ownership:	[ ] Yes [ ] No
		[ ] Current Client	[ ] Previous Client

Corporate Structure
[ ] Corporation	[ ] Partnership	[ ] Proprietorship	[ ] Other: _________
Authorized Bank Signing Officer		Name:	Title:
Authorized Bank Signing Officer		Name:	Title:

Trade References
	1	2	3
Company
Address
Phone/Contact

Bank Information
Section A	Bank and Account Number
How long at this branch?	(If less than 2 years, complete section B also)
Address
City		Province/Postal Code
Contact name		Phone number
Attach any relevant banking information (eg. loans, NSFs, bankruptcy, etc.)

Section B: Prior banking information	Bank and Account Number
How long at this branch?
Address
City		Province/Postal Code
Contact name		Phone number
Attach any relevant banking information (eg. loans, NSFs, bankruptcy, etc.)

Shareholder Information
#1) Name:		Title
Address			Ownership: %
Address
		Phone	(____)___________
S.I.N.		Birth Date
Background
Bank		Account Number
Address
City		Province/Postal Code
Contact name		Phone number
Attach any relevant banking information (eg. loans, NSFs, bankruptcy, etc.)
#2) Name:		Title
Address			Ownership: %
Address
		Phone	(____)___________
S.I.N.		Birth Date
Background
Bank		Account Number
Address
City		Province/Postal Code
Contact name		Phone number
Attach any relevant banking information (eg. loans, NSFs, bankruptcy, etc.)

The undersigned certifies the above information to be true and correct. By signing below, I/we consent to the obtaining from any credit reporting agency or credit grantor, such information as DRC Instruments and/or its assignees may require at any time in connection with the credit hereby applied for and consent to the disclosure at any time of any information concerning the undersigned to any credit reporting agency or to any credit grantor with whom the undersigned has financial relations.
Authorized signature(s) of clients(s)
	X	X	X
	Signature	Signature	Signature

	Print Name	Print Name	Print Name

	Date	Date	Date

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