Cardlock Credit Application

Legal Business Name*

Mailing Address*

City*

Province*
OntarioAlbertaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutPrince Edward IslandQuebecSaskatchewanYukon

Postal Code*

Name

Phone*

Phone Alt

Fax

Name of Business*

Date Established*

Principal's Full Name*

Principal's Title

Is Operation Trade Registered?
YesNo

Date of Incorporation

Product For Tank 1

Tank 1 Size

Product For Tank 2

Tank 2 Size

Number of Cardlock Pins Required
123456

Provide 4 Digit PIN #’s for each card requested, separate by comma.

Bank

Branch

Contact Name

Phone

Fax

Credit Required (per month)

Current Fuel Supplier

Name

Phone

Fax

Name

Phone

Fax

Name

Phone

Fax

Name

Phone

Fax

Full Name*

Address*

City*

Province*
OntarioAlbertaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutPrince Edward IslandQuebecSaskatchewanYukon

Postal Code*

Birthdate

Phone

Business/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 Fuels

The Customer hereby certifies that the information provided to Bird Fuels is true and correct and agrees to abide and be bound by the terms and conditions set out in this application. The applicant acknowledges and agrees to credit responsibility for all purchases on the Account as outlined in the Terms and Conditions herein. Authority is granted to Bird Fuels to verify with Credit Reporting Agencies, Credit References and other sources disclosed herein to adjudicate credit terms.

I agree to the Terms of Service*
Yes

Date*

Email*