Business Credit Application Business InformationBusiness Name*Type of Operation*ProprietorshipPartnershipIncorporatedBusiness Start Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Business Type*Business Address* Street Address City Province Select ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Business Phone*Business Email Address* Business Website URL A/P ContactA/P Contact Name* First Last A/P Contact Phone*A/P Contact Email Address* Head OfficeHead Office Address* Same as previous Street Address City Province Select ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code BillingBilling Address* Same as previous Street Address City Province Select ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Email Statements/Invoices?*YesNoStatements/Invoice Email Address* PrincipalPrincipal Name* First Last Principal Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Principal Residence Address* Same as previous Street Address City Province Select ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Principal Phone*Principal Email Address* Bank ReferenceBank Name*Bank Branch #*Bank Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Trade ReferencesTrade Reference #1 Name* First Last Trade Reference #1 Phone*Trade Reference #1 Email Address Trade Reference #2 Name First Last Trade Reference #2 PhoneTrade Reference #2 Email Address ProductsProducts Required* 24 hr. Fuel Access Bulk Tanks Furnace Fuel Keylock Lubes Propane FOBS Required*FOBS Access*Select all products you require access to with your FOBS. Gasoline Clear Diesel Dyed Diesel Vehicle Propane Fuel and Propane Delivered Bulk Gasoline Clear Diesel Dyed Diesel Vehicle Propane Lubricants Packaged Bulk Home Heat Propane Furnace Oil Terms & ConditionsYou must agree to the following to submit your application* The person(s) submitting this form certifies the above information to be true and agrees to pay all accounts upon receipt, and further agrees to guarantee personally the payment of all monies which shall become due to DOWLER-KARN LIMITED from the above name business. The applicant is made with the understanding and agreement that all charges for products, parts, material and labour will be assessed a service charge on all overdue amounts at the rate specified on our invoices. I am the applicant named herein, and herby authorize DOWLER-KARN LIMITED TO OBTAIN FROM ANY CREDIT STANDING, ALL PERSONAL AND/OR FIRMS CONTACTED FOR SUCH PURPOSE MAY FREEELY GIVE ANY INFORMATION CONCERNING ME AND I HEREBY WAIVE ALL RIGHT OF ACTION FOR ANY CONSEQUENCES RESULTING FROM SUCH INFORMATION. Jack & Joyce Karn Collection Featuring More Than 10,000 Items at The Dowler-Karn Museum in St Thomas. Learn More In the Community Supporting Local Events & Communities Across Southwestern Ontario Learn More
