Credit Application Form

You may fill out the Credit Application Form below, or alternatively, you may fill out this PDF and email it to us at brenden@thombc.com.

Supplier & Transaction Details

Supplier

Sales Representative Name*

Email*

Contact Number*

Equipment Description*

Equipment Condition*NewUsed

Year (Equipment)

Cost*

Term*

Payment Frequency*

Trade-in

Customer Details

Legal Name of Company (if applicable)*

Business Type*Ltd. / Inc.PartnershipProprietership

In Business Under Current Ownership Since:

Operating Name (If Applicable)

Type of Business*

Number of Employees (Required Answer if In Québec)

Mailing Address*

Province*

City*

Zip/Postal Code

Country*

Billing Address*

Province*

City*

Zip/Postal Code

Country*

Contact Name

Contact

Email*

Contact Number*

Business Website*

PST/QST Number

Landlord / Mortgagee Holder

Landlord / Mortgagee Holder Contact Number

Additional Applicant / Guarantor 1

Name (Applicant / Guarantor)

Date of Birth

Social Insurance Number (Optional)

Phone

Home Address

Province*

City*

Zip/Postal Code

Country*

Additional Applicant / Guarantor 2

Name (Applicant / Guarantor)

Date of Birth

Social Insurance Number (Optional)

Phone

Home Address

Province*

City*

Zip/Postal Code

Country*

I/We the applicant, principal and/or guarantor each:

1) Acknowledge that providing a social insurance number is optional and not a condition to obtaining a credit review;*

2) Consent to the collection, use and disclosure of personal information for the purposes of credit adjudication by the Lessor/Lender and its funders and to enable the Lessor/Lender and its assignees to provide financing and to promote the products and services of the Lessor/Lender and its affiliates; and *

3) Consent to the Lessor/Lender and its funders obtaining information relating to the applicant, principal and/or guarantor from credit reporting agencies in connection with this application. *

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Credit Application Form

Supplier & Transaction Details

Customer Details

Additional Applicant / Guarantor 1

Additional Applicant / Guarantor 2

Brokerage

consulting

About Us

Thom Brokerage & Consulting

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