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Interested in getting a cardlock card?

    Business Information

    Legal Business Name*

    Mailing Address*

    City*

    Province*

    Postal Code*

    Account Payable Contact

    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

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

    Banking Information

    Bank

    Branch

    Contact Name

    Phone

    Fax

    Credit Required (per month)

    Trade Information

    Current Fuel Supplier

    Please list four (4) trade references (Companies with which you currently have an active account)
    Reference #1

    Name

    Phone

    Fax

    Reference #2

    Name

    Phone

    Fax

    Reference #3

    Name

    Phone

    Fax

    Reference #4

    Name

    Phone

    Fax

    Principal Owner

    Full Name*

    Address*

    City*

    Province*

    Postal Code*

    Birthdate

    Phone

    Terms & Conditions

    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*

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