KEMPTER MARKETING
764 Lajoie Ave.
Dorval (QC)
H9P 1G8
CREDIT APPLICATION & AGREEMENT
Legal Name (in full) of Applicant:D.B.A. (Trade Name):
Shipping Address:
City: / Province: / Postal Code:
Telephone: ( ) -
Facsimile: ( ) -
E-mail:
G.S.T. # P.S.T. #
Immatriculation #:
Corporation / Sole Proprietorship / Partnership
Principals/Owners / Birth Date / Title / Home Address / Telephone
MM / DD / YYYY / ( ) -
MM / DD / YYYY / ( ) -
Accounts Payable Contact: / ( ) -
Date Business Commenced:
Number of Employees: Full-Time: Part-Time :
Are you a member of a Buying Group? : YES NO / If Yes, Member #:
If New Business:
Initial Capital Invested: / $
Loans: / $
Shareholders:
Name of Bank:
Contact: Account No.:
Address of Bank:
Operating Line of Credit: / $
Long Term Loans:
The following are all of the parties holding General Security Agreements on the assets of Applicant:
1.2.
3.
Opening Credit Required: / $
High Credit Required: / $
Financial Statement is Attached: YES NO
PREMISES
Leased / Owned by Applicant / Owned by Related PartyNumber of Square Feet (net):
Price per Square Foot (net): / $
Building Type:
Lease Expiry: / MM / DD / YYYY
Landlord Name: / Telephone: ( ) -
PRODUCT LINE(S)
Hockey/Licensed Products/Team Sports / Outdoor / Cycling Athletic Footwear/Racquet / Ski / Golf
Fishing & Hunting / Snowboard / Fashion Footwear
Eyewear / Other (Specify)
Percentage of Sales to:
Equipment: _____% / Apparel: _____%
Accessories: _____% / Footwear: _____%
Sales Volume (Combined):
$499,999 and under / $500,000 - $999,999
$1,000,000 - $1,499,999 / $1,500,000 - $2,999,999
$3,000,000 - $4,999,999 / $5,000,000 and over
MAJOR TRADE SUPPLIERS
Supplier #1 / Supplier #2 / Supplier #3Name:
Address:
City, Province:
Postal Code:
Phone:
In order for you to decide upon the issuance of credit I/We hereby authorize our accountant and bank to furnish you with all necessary information. I/We also authorize you to conduct all pertinent credit investigations concerning the buyer, its owners and/or principals and to exchange financial & other relevant information with your suppliers, credit agencies and any other source deemed necessary.
Authorized by: ______Signature: ______MM / DD / YYYY
(B) AGREEMENT
The signature below attests that the applicant is financially responsible and solvent & that the information and statements in this credit application are true and accurate.
The Applicant understands and agrees that the following TERMS and CONDITIONS shall apply to all sales to be made by Supplier to Applicant.
1. INTEREST. Amounts not paid by due date specified on invoice are subject to a monthly interest charge of ____% per month (____% per annum).
2. TRANSPORT. The Applicant assumes all costs pertaining to delivery of merchandise.
3. LOSS. The Applicant assumes all risk of loss of, or damage to, merchandise during transport.
4. QUANTITY. Part shipments may be made and orders shall be considered complete if the Supplier is unable to deliver the entire order. In such event the Applicant waives its right to claim a reduction in price or cancellation of sale.
5. LATE DELIVERY. The Applicant shall not cancel an order due to late delivery unless the Supplier has been notified in writing prior to shipment.
6. RETURNS. No merchandise may be returned without prior written authorization of the Supplier.
7. REFUSAL TO SHIP. The Supplier may refuse to ship any confirmed order in whole or in part for any reason it deems sufficient.
8. OWNERSHIP OF PRODUCT. Unless otherwise agreed to in writing, the Supplier retains ownership (Security Interest) of all merchandise shipped until paid for in full by the applicant
LANGUAGE. It is the express wish of the Applicant that this credit application and agreement be written in the English language. Le Demandeur désire que la présente demande de cr édit et entente soient rédigees en anglais.
SIGNED at ______this _____ day of ______, 20___ .
______
APPLICANT & TITLE
Per:______
Authorized representative
THE FOLLOWING SECTION SHOULD BE COMPLETED BY THE PROPRIETOR WHERE THE APPLICANT IS NOT AN INCORPORATED COMPANY.
(C) CONSENT
I agree that in order for you to evaluate your granting of credit terms to me or my business operations and the continuing monitoring of my credit status which includes ongoing eligibility for credit, a personal information file containing credit and necessary related personal information may be formed.
I may at any time withdraw consent to all or any part of the foregoing in which event you may cease doing business with me on a credit basis. Employees of yours, whose job description involves assessment of credit worthiness, shall have access to my file.
My social insurance number will be used only to identify me with credit bureaus and others for credit history file evaluation.
I further consent to your obtaining, disclosing and exchanging any credit and necessary personal information about me contained in my file at any time, from, to or with any credit bureau or other party doing business with me in connection with any dealings between us presently or to be commenced.
I understand that the information in my file shall be used only for the specific purpose mentioned and in the manner hereinabove described.
______, 20___
Date
______
Name of individual
______
Doing business as
______
Signature of individual