New Client Account

Business Information
Legal Entity Name*
Common Alternate Company Trade Names*
Number of Years in Business*
Legal Formation Type
Business Activities/Industries*

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Contact Information
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Email Address*
Primary Phone Number*
Secondary Phone Number
Fax
Website

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Shareholders
List Shareholders with Material Stake*
First Last Telephone Email

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Banking Information
Financial Institution Name*
Institution Number*
Transit Number*
Account Number*
Date of Account Opening
Date Format: MM slash DD slash YYYY
Institution Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Institution Phone Number*
Institution Fax Number*
Institution Contact Person*
First Last

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Credit References
Please provide a minimum of three (3) credit references.*
Company Addresse Telephone Fax Email Contact

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Accounts Payable Options
Purchase order required (PO)?*
- Yes
- No
Require a reference number on our invoices?
- Yes
- No
Preferred Payment Method
- Cheque
- Electronic funds transfer
Name of Contact Person*
First Last
Email Address*
Telephone Number*
Fax Number*

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Other Information
GST Number*
QST Number*
What is the requested credit limit?*
Estimated Annual Sales at EWMC*
Total Annual Revenue
Last Fiscal Year End Date
Date Format: YYYY dash MM dash DD

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Consent and Agreement
Accept and Signature*
- Yes, this is affirmative; I accept and I consent.
The client accepts that payment terms are Net 30 days, with 2% interest monthly (or 24% annual) for all accounts outstanding. Invoices and statements of account are assumed correct, accurate and final, if the client does not notify EWMC by written notice within 10 days of the invoice date. The client accepts to assume all costs in the event that EWMC incurs expenses or financial loss in the collection of oustanding and/or unpaid accounts, such as NSF bank fees, legal fees, and all other general fees. In assuming such costs, the client will reimburse EWMC completely, and renounces all benefit of discussion, negotiation or division. The client accepts to promptly notify EWMC in writing, of all changes to its business which may affect the credit and credit conditions agreed to by EWMC. Such instances include changes to available funds, working capital, profitability, going concern, changes in management, structure, governance, and/or ownership. In such circumstances a new credit application and convention must be established. The client accepts that if the client fails to respect the conditions prescribed in these terms and conditions, the totality of the debt outstanding by the client will become due and payable at a time of the discretion of EWMC, which may be immediately, notwithstanding contradictory dispositions. The client accepts that EWMC reserves the right to revise and amend, by increasing or decreasing, the authorized credit limit, at its discretion. The client accepts that EWMC shall not be held responsible, directly or indirectly, for any loss, expense or damage incurred by the client from an amendment or withdrawal, whether temporary or permanent, to the credit privileges allocated under this agreement. The client accepts that no merchandise may be returned without the consent and approval of EWMC, and that in cases of breach of this term, the client may be charged handling fees, as well as other fees as prescribed in any specific sales agreement. I, the undersigned, understand and accept the above terms and conditions, declare that all information provided in this application form is truthful, and understand that this informaton is subject to verification.
Your Full Name*
First Last
Your Title/Position*
Your Email Address*
City*
Enter the name of the city in which you completed this form.
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Create your EWMC client account

Step 1 of 8

Business Information

Contact Information

Shareholders

Banking Information

Credit References

Accounts Payable Options

Other Information

Consent and Agreement

Heavy Duty Mechanic, Level 1, 2 and 3

Heavy Duty Mechanic

First	Last	Telephone	Email

Company	Addresse	Telephone	Fax	Email	Contact