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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