Goldcard Leasing : Business Credit Application Form

Business Credit Application Form

General Information / Renseignements Généraux

Legal Company Name / Raison Sociale
Trade Name of Business / Nom Commercial
Street Address / Adresse Municipale

City

Province

Postal Code
Telephone No. / No. de Téléphone

Fax No. / No. de Télécopieur
Email / Courriel
Contact Name / Nom du Contact

Title / Titre
Nature of Business / Genre de Commerce (max. 250 characters)
Year in Business / Nombre d'Années d'Exploitation
Number of Employees / Nombre d'Employés

Date of Incorp. (M/D/Y) /
Date de Constitution en Société (M/J/A)

Shareholder Information / Renseignements sur les Actionnaires

Name / Nom

% / %
Home Address

City

Province

Postal Code
Date of Birth (M/D/Y) / Date de Naissance (M/J/A)

SIN (optional) / No d'Assurance Sociale (facultatif)
Limited Company / SARL Partnership/SENC Proprietorship / Enterprise Individuelle
Other / Autre
Describe / Description (max. 250 characters)

Financial Information / Renseignements Financiers

Bank / Institution Financiére

Telephone No. / No. de Téléphone

Fax No. / No. de Télécopieur
Branch / Succursale

Account No. / No de Compte

Contact / Nom du Contact

Equipment and Supplier Information /
Renseignements sur L'Équipement et Le Fournisseur

Supplier Name and Location / Nom et Lieu du Fournisseur
Telephone / Téléphone

New / Neuf Old / D'Occasion
Equipment Description (Include Make and Model) / Description de l'Équipement (incluant la marque et le modèle

(max. 250 characters)
Total Cost $ (Before Taxes) / Cout Total (Avant Taxes)

Lease Term / Durée du Bail
Down Payment $ / Acompte $
Other Information / Autre Information (max. 250 characters)

Gold Card Representative

Please direct this application to:

In this application, (I) the words “you” and “your” refer to the Lessee Applicant named above and (ii) the words “we” and “our” refer to GOLD CARD LEASING and its successors.

You consent to our collection of your credit, financial and related personal information, and to the exchange of this information between us, credit bureaus, financial institutions and other persons with whom you have had or may have financial dealings, and to our use of this information for the purposes of: verifying and evaluating your creditworthiness and other information you provide to us in connection with your account; establishing, servicing and collecting on your account; providing the products and services you request; providing credit references; communicating with you for these purposes and for legal and safety-related purposes; and meeting legal, regulatory, audit, processing and security purposes, and as otherwise permitted or required by law. Your Social Insurance Number, if provided, will be used for identity verification, including matching credit information.

In addition to the purposes above, we assume that you consent to our use of your contact information to provide you with occasional information about other products and services offered. However, you may refuse consent for this purpose by contacting us in writing at #103-1120 FINCH AVE. W., NORTH YORK, ONTARIO M3J 3H7. To request access to or correction of your personal Information, or for more information about our privacy Practices, see our Privacy Policy at www.goldcardleasing.com