CARQUEST Canada

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TECH-NET

CARQUEST
Technical Institute

LONDON Leasing

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Application (pdf)

LONDON Leasing - Application

Legal Name of Company:

(required)

Billing Address:

(required)

City:

(required)

Province:

(required)

Postal Code:

(required)

Email:

Phone:

(required)

Fax:

Description of Business:

Years in Business:

Federal Tax ID:

Servicing CARQUEST Store:

TECH-NET Member:

Yes
No

Type of Business:

Corporation
Partnership
Proprietorship

Other

Personal Information For Officers, Partners or Owners

Owner Name:	(required)
Percent Owned:	%
Home Address:
City:
Province/Province:
Postal Code:
Social Security Number:
Phone:

Additional Owner

Owner Name:
Percent Owned:	%
Home Address:
City:
Province:
Postal Code:
Social Security Number:
Phone:

Required Payment Method

Direct Payments (ACH Debits):	Yes No
Recurring Credit Card Payments:
Customer CARQUEST Account Number:

Company Checking Account(s)

Name of Bank:
City:
Province:
Phone:
Checking Account Number:

Trade References

Company Name:
City:
Province:
Phone:

Company Name:
City:
Province:
Phone:

Company Name:
City:
Province:
Phone:

Equipment Information - (optional)

Manu.
Model
Desc.
Year
Price

Manu.
Model
Desc.
Year
Price

Term Request:

Purchase Option:

How would you describe your credit rating? Good bad or severely damaged?

RELEASE
The undersigned hereby consent(s) to LONDON Leasing use of a non-business consumer credit report on the undersigned as a principal(s), proprietor(s), and/or guarantor(s) in connection with the extension of business credit as contemplated by this credit application. The undersigned hereby authorize LONDON Leasing to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this credit application. The undersigned as (an) individual(s) hereby knowingly consent(s) to the use of such credit report consistent with the Federal Fair Credit Reporting Act as continued in 15 U.S. C. 1681 et seq.

I Agree: Type your name if you agree. (required)