Credit App Established - Camex Equipment

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CAMEX EQUIPMENT SALES & RENTALS INC. 1806 - 2 Street, Nisku, AB T9E 0W8 Tel: 780.955.2770 Toll Free North America: 877.955.2770

CREDIT APPLICATION FINANCE: Fax: 780.955.3735 [email protected]

RENTALS: Fax: 780.955.5509 [email protected] EQUIPMENT FINANCING

Please select appropriate box to start:

EQUIPMENT RENTALS

Business (Legal Name): Operating as: Same

PARTS: Fax: 780.955.5588 [email protected] PARTS PURCHASING

Corporation

Partnership

Or as:

How Long in Business: Street:

Legal Address: Tel:

Proprietorship

Town/City:

Cell:

Province/State:

Fax:

Years

Postal/Zip Code:

Email:

Website:

Physical Address/Legal Land Description:

Management Structure: Key Officers Name:

Title Ownership:

%

Name:

Title Ownership:

%

Name:

Title Ownership:

%

Have any of you ever been bankrupt?: Yes

No

Social Security #:

Date of Birth (mm/dd/yyyy):

Social Security #:

Date of Birth (mm/dd/yyyy):

Social Security #:

Date of Birth (mm/dd/yyyy):

Have any of you ever had a repossession?: Yes

No

If yes to either of the above questions, please provide details: Are you a Home Owner?: Yes

No

Nature and History of Business:

Business Assets and Business Liabilities: Asset Description:

Value:

Total Business Assets:

Creditor Name & Address:

0.00

Monthly Payment:

Balance Owing:

Total Business Debts:

0.00

Total Business Assets - Total Business Debts = Net Worth:

0.00

The Applicant(s) affirm that all information given above is true and complete. The Applicant(s) consent to Camex Equipment Sales & Rentals Inc. obtaining from any Credit Reporting Agency or Credit Grantor such information as the dealer may require at any time in connection with the credit hereby applied for and consents to the disclosure or exchange at any time of any information concerning the applicant(s) to any Credit Reporting Agency or Credit Grantor with which the dealer deals.

Date:

04/07/2017

Applicant’s Signature:

Date:

04/07/2017

Applicant’s Signature:

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