Cardlock Interested in getting a cardlock card?Legal Business Name*Mailing Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Accounts Payable Contact First Last Phone*Phone (Alt)FaxName of Business*Date Established Principal's Name First Last Principal's TitleIs Operation Trade Registered? Yes NoDate of Incorporation ProductTank SizeProductTank SizeNumber of Cardlock Pins Required123456Please Provide 4 Digit PIN #’s for Each Card RequestedPress the plus sign to the right to add more PIN #'s Banking InformationBankBranchContact Name First Last PhoneFaxCredit RequiredPer monthTrade InformationCurrent Fuel SupplierPlease list four (4) trade references (Companies with which you currently have an active account)Press the plus sign to the right to add contacts.NamePhoneFax Principal OwnerName* First Middle Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Birthdate PhoneTerms and ConditionsBusiness/Farming Agreement*The Applicant is aware and fully understands that (please read and check off each option): Accounts are to be paid in Full 30 days from date of statement A service charge of 2% per month (24% per annum) will be charged on all past due accounts. In the event of non-payment when demanded, Bird Fuels will exercise all legal means at its disposal to collect the account without further notice. Any cost incurred in effecting recovery (including legal) will be added to the account and will become the responsibility of the customer. Tendering an N.S.F. cheque automatically terminates credit privileges. Bird Fuels reserves the right to revoke charge privileges at any time, for any reason In consideration of Bird Fuels extending credit to a corporation or proprietorship, I/We personally guarantee the indebtedness of the corporation or proprietorship to Bird FuelsThe Customer hereby certifies that the information provided to Bird Fuels is true and correct andagrees to abide and be bound by the terms and conditions set out in this application. The applicantacknowledges and agrees to credit responsibility for all purchases on the Account as outlined in theTerms and Conditions herein. Authority is granted to Bird Fuels to verify with Credit ReportingAgencies, Credit References and other sources disclosed herein to adjudicate credit termsI agree to the Terms of Service* YesDate Email* PhoneThis field is for validation purposes and should be left unchanged.