Credit Application

Fill out and submit the following form to apply for a Credit account with HESCO. You may also download and fax our application to (780) 428-0782.

Download the Credit Application

* - Mandatory Field

Date:	February 6, 2012
Legal Name (of Business): *
Operating Name (of Business): *
Address: *
City: *
Province: *
Postal Code: *
Mailing Address
Address:
City:
Province:
Postal Code:

Phone Number: *
Fax Number:
Email Address: *
Amount of Credit Required:
Nature of Business:
P/O Required:
Tax Number:
Company is a:	Corporation: Partnership: Sole Proprietorship:
Date Established:
Principals / Owners
Principal #1
Name:
Title:
Drivers License:
Date of Birth:
Address:
City:
Province:
Postal Code:
Phone Number:

Principal #2
Name:
Title:
Drivers License:
Date of Birth:
Address:
City:
Province:
Postal Code:
Phone Number:

Principal #3
Name:
Title:
Drivers License:
Date of Birth:
Address:
City:
Province:
Postal Code:
Phone Number:

References
Reference #1
Supplier:
Address:
City:
Province:
Postal Code:
Phone Number:
Fax Number:
Contact:

Reference #2
Supplier:
Address:
City:
Province:
Postal Code:
Phone Number:
Fax Number:
Contact:

Reference #3
Supplier:
Address:
City:
Province:
Postal Code:
Phone Number:
Fax Number:
Contact:

Financial Institution
Bank:
Address:
City:
Province:
Postal Code:
Phone Number:
Fax Number:
Account No.:
Contact Person:

I / We		and		of
	(name of principal) *		(name of principal)		(name of company) *

(hereinafter referred to as the corporate customer), apply for credit for the supply of goods, services and materials in accordance with the application for credit concurrently made. I/We being principal(s) of the corporate customer acknowledge that I/we am/are co-customer( s)/co-purchasers and will be personally responsible jointly and severally with the corporate customer for any and all debts I/we will jointly and severally indemnify you, and see you paid for your account with respect to any order now or hereafter made by the corporate customer. I/We further agree to pay your account within your terms of payment following purchase, to pay 2% interest and service charges per month (24% per annum) on overdue accounts and I/we assure full responsibility for any costs incurred toward collection of account including legal fees. For the purposes of this credit transaction I/We fully consent and authorize yourselves obtaining any personal credit information through any credit bureau, credit reporting agency, government registry, private registry, civil enforcement agency, or Schel Management Credit.

I Agree to the Terms and Conditions above

Credit Application

Principals / Owners

References

Financial Institution