Your Retail - Apply for Credit

Applicant's Information

Complete Legal Business Name (hereinafter known as applicant) *

Are you a *

Sole Proprietorship
Patnership
Incorporated

Operating as (if applicable):

Mailing Address:

Street: *

Apt:

City: *

Postal Code: *

Email: *

Bus Phone: *

Fax:

Cell:

Accounts Payable

Contact Person: *

Phone: *

Email: *

Owner(s)/Officers(s)

First Name: Owner/Officer #1 *

Last Name: *

Date of Birth (mm/dd/yyyy) *

Street: *

Apt:

City: *

Postal Code: *

First Name: Owner/Officer #2

Last Name:

Date of Birth (mm/dd/yyyy):

Street:

Apt:

City:

Postal Code:

Landlord Information

Landlord First Name:

Landlord Last Name:

Landlord Phone:

Banking Information

Financial Institution: *

Street: *

City: *

Contact First and Last Name: *

Contact Phone: *

Submit Your Application

I HAVE READ AND AGREED TO THE TERMS AND CONDITIONS *

BEFORE SUBMITTING ANY INFORMATION TO US PLEASE READ, UNDERSTAND AND AGREE TO THE FOLLOWING TERMS AND CONDITIONS

The Applicant certifies that the above information is true and correct. By submitting this application electronically, the Applicant authorizes McDougall Energy Inc. or its agent to conduct credit history checks for the purposes of credit approval. The Applicant further agrees that this authorization is ongoing and to be used by McDougall Energy Inc. only when reasonably necessary for the purposes of monitoring the Applicant’s account and/or for debt collection. The Applicant further authorizes McDougall Energy Inc. or its agent to contact banking and trade references. McDougall Energy Inc. collects credit information for the purpose of credit approval, account monitoring and debt collection only. We do not distribute, sell or disclose any customer information without consent or unless required to do so by law. Our files are kept secure. Our privacy policy is available upon request. By submitting this application electronically, the Applicant agrees to keep their account current and in good standing. Interest in the amount of 2% per month shall be charged for all accounts past due. The Applicant further agrees that should collection proceedings or legal action be necessary to collect on the Applicant’s account, the Applicant agrees to be responsible for all costs incurred by McDougall Energy Inc. or their authorized agent, to collect payment.