Credit Application Form

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1 - Company Data

Fieldset: Street Address. Use tab key to navigate between form elements within this group.
Fieldset: Province. Use tab key to navigate between form elements within this group.
Fieldset: City. Use tab key to navigate between form elements within this group.
Fieldset: Postal Code. Use tab key to navigate between form elements within this group.
Is Mailing Address same as Street Address
Use spacebar or enter key to select this option. Only one option can be selected. Current state: selected.
Use spacebar or enter key to select this option. Only one option can be selected. Current state: not selected.
Is Mailing Address same as Street Address
Is Mailing Address same as Street Address radio group. Use tab key to navigate between options, spacebar or enter to select.
Fieldset: Is Mailing Address same as Street Address. Use tab key to navigate between form elements within this group.
Type of Business
Use spacebar or enter key to toggle this checkbox. Current state: unchecked.
Use spacebar or enter key to toggle this checkbox. Current state: unchecked.
Use spacebar or enter key to toggle this checkbox. Current state: unchecked.
Use spacebar or enter key to toggle this checkbox. Current state: unchecked.
Type of Business checkbox group. Use tab key to navigate between options, spacebar or enter to select.
Fieldset: Type of Business. Use tab key to navigate between form elements within this group.
Purchase Orders Required? *
This field is required. Use spacebar or enter key to select this option. Only one option can be selected. Current state: selected.
This field is required. Use spacebar or enter key to select this option. Only one option can be selected. Current state: not selected.
Purchase Orders Required?
Purchase Orders Required? radio group. Use tab key to navigate between options, spacebar or enter to select.
Fieldset: Purchase Orders Required?. This field group is required. Use tab key to navigate between form elements within this group.

2 - Banking Data

3 - Credit References (3 Required)

4 - Signatures

The information furnished on this page is for the purpose of obtaining credit from Energy Safety Canada. Each signatory below represents and confirms that such person has authority to bind the applicant and company and that the information provided in this application is true and correct. The applicant company accepts and agrees that: (a) payment of accounts approved for credit are due upon registration for course and on date of invoice for purchases of books and materials; (b) Energy Safety Canada has the right to charge interest on accounts outstanding after 30 days and at the date of this application the interest rate chargeable by Energy Safety Canada has been set at 18% per annum compounded monthly and calculated daily (or the maximum rate chargeable in the province in which the transaction is conducted, whichever is lesser); (c) Energy Safety Canada has reserved the right to amend its credit terms at any time; and (d) in addition to charging interest and taking any steps it deems fit for collection of outstanding and overdue accounts, Energy Safety Canada has reserved the right to suspend any and all future registrations and purchases by the applicant company should any of its accounts be outstanding or overdue at any time.

5 - Personal Guarantee

Personal guarantee – in consideration of credit being extended to the above named firm I personally guarantee all indebtedness hereunder. I further agree that this guarantee is an absolute, completed, and continuing one and no notice of the indebtedness or any extension of credit already hereafter contracted by or extended need be given; that I will pay the amount due within five days of notice that the account is past due.