Personal Request for Credit – Smitherslumber.com

First Name

Last Name

Date of Birth

S.I.N (for ID purpose only)

Spouse First Name

Spouse Last Name

Date of Birth

S.I.N (for ID purpose only)

Date of Birth

S.I.N (for ID purpose only)

Mailing Address

City/Town

Postal code

Street Address

Home Phone

Work Phone

Fax

*Email

Present Employer

Occupation

Bank

Contact

Personal References

Contractor Name

Other Reason

HOW MUCH CREDIT ARE YOU APPLYING FOR? (In $ Per Month)

ALSO AUTHORIZED TO CHARGE: no one other than those named below will be allowed to charge

HAVE YOU HAD AN ACCOUNT WITH US PREVIOUSLY?

Yes

AIRMILES #

PAYMENT TERMS.

It is understood that this account is due and payable IN FULL on or before the 15th of the month following the invoice date(s). It is hereby agreed that these payment terms will be honoured.
NOTE: Your account will be paid off at the end of the month/by the 15th(+/-) of the next
month (if you have not already paid it off) with the credit card # you provide
Please provide credit card # ______________________________________________ Expiry____________
FINANCE CHARGE: It is also understood that a finance charge will be added if not paid in full by the 15th of the month
following. The finance charge is computed by applying a periodic rate of 2% per month.
ANNUAL PERCENTAGE RATE IS 26.82%..
It is hereby agreed that this finance charge will be honoured.

THE ABOVE INFORMATION IS FOR THE PURPOSE OF OBTAINING CREDIT AND IS WARRANTED TO BE TRUE.

I HEREBY AUTHORIZE SMITHERS LUMBER YARD LTD. TO OBTAIN SUCH CREDIT REPORTS OR OTHER INFORMATION AS MAY BE DEEMED NECESSARY IN CONNECTION WITH THE ESTABLISHMENT AND MAINTENANCE OF A CREDIT ACCOUNT. THIS CONSENT IS GIVEN PURSUANT TO SEC. 12 OF THE CREDIT REPORTING ACT, R.S.B.C. 1979, CH. 78.

WARNING: ALL ACCOUNTS OVER 90 DAYS ARE AUTOMATICALLY REPORTED TO THE NATIONAL CREDIT FILE.

Photocopy of Applicant’s Drivers License:

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