Account Application

Business Information

Legal Business Name*

Doing Business As:

(optional)

First Name:*

Last Name:*

Email:*

Business Phone*

Business Street Address*

Address Line 2

(optional)

City*

Postal Code*

Province*

Have you been in business more than a year but at your current address for less than 12 months?:*

Financial Statement Available

Billing Information

Same As Business Address

First Name*

Last Name*

Phone*

Fax

(optional)

Street Address*

Address Line 2:

(optional)

Postal Code*

Province*

Additional Information

GST/HST Number*

Legal Structure*

Estimated Monthly Purchases*

Years Incorporated*

Bank Information

Name and Branch*

Account Number*

Name on Bank Account*

Phone*

Fax

(optional)

Account Rep*

Account Rep Email*

Commercial Credit References

Credit Reference 1

Commercial Name*

First Name*

Last Name*

Address*

Address Line 2

(optional)

City*

Province*

Postal Code*

Email*

Credit Reference 2

Commercial Name*

First Name*

Last Name*

Address*

Address Line 2

(optional)

City*

Province*

Postal Code*

Email*

Terms and Conditions

Kawartha Business Equipment Ltd owns and operates Kawartha Business Equipment, also referred to as KLBE. The Customer consents to KLBE collection, use and sharing of the personal information (the "Account holder Information") provided in this application or complied internally by KLBE for the purpose of offering the Customer an Account for office equipment and supply purchases. The Customer acknowledges and agrees that KLBE will determine the account limits that best suits the Customer's needs based on the Customer's estimates of monthly purchases, and periodic review. If it is determined that the Customer is best served by an account, KLBE will process the Customer's application for an Account and forward additional documentation regarding the Account to the Customer. The Customer may charge goods and services up to the credit limit set by KLBE and must pay the full balance as shown on each monthly billing statement, according to the general terms and conditions of the agreement (the "Agreement") relating to the Account. The Customer agrees with KLBE to abide by and be bound by the terms and conditions set out in the Agreement. By signing this Application the Customer represents and warrants that: (a) it is a valid business entity or a self employed professional or business person, and duly registered as such under all applicable laws; (b) all purchases made on the Account, if approved, will be for business purposes and shall not include personal, family, or household use; (c) the individual signing the Application is an authorized representative of the business with authority to enter into contractual agreements; and (d) the account holder Information is complete and accurate. KLBE will, from time to time, use or disclose the Cardholder Information, and information obtained subsequently from any source with the Customer's consent (collectively the "Information") to obtain credit reports from credit reporting agencies and to contact credit references and other sources disclosed herein as part of its assessment of the Information. For any questions regarding the Information or Purposes, please call 1-705-324-2303. The Customer consents to KLBE 's use of the Information for the Purposes or in accordance with applicable law. Customer also understands that credit on the Account, once approved, will be extended by KLBE, and that there will be no-binding contract between the Customer and KLBE until KLBE approves and accepts this Application.

Authorized Signature

First Name*

Last Name*

Title*

Phone*

Email*

*

I have read and agreed to the Terms and Conditions Above

Name

This field is for validation purposes and should be left unchanged.

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