Finance Application

LESSEE INFORMATION
Legal Name:*
First Last Suffix
Address:*
City:*
Province:*
Postal Code:
Type of business:*
Telephone:*
Mobile:
Fax:
Since:
Bank Information
Type:
- Commercial
- Personal
Account owner name:
First Last Suffix
Address:*
City:*
Province:*
Postal Code:
Telephone (Mobile):
Telephone (Home):
Fax:
Account Number:
Line of credit ($):
Utilised ($):
SUPPLIER INFORMATION
Company: Pierquip Inc.
Adress: 16079 Curé-Labelle
City/Province: Mirabel, Qc
Postal Code: J7J 2G6
Contact : [email protected]
Telephone : 450.438.6400
Fax : 450.438.1090
EQUIPEMENT DESCRIPTION
Attach quote to the credit application
Quanity:
Description:
Price ($):
PAYMENT TERMS
Total Cost ($):
Deposit ($):
Financed Amount ($):
Term (Months):
Exchange Value ($):
PERSONAL INFORMATION
Name 1:
First Last Suffix
Address:*
City:*
Province:*
Postal Code:
Telephone (Mobile):
Telephone (Home):
Social Insurance Number:
Date Of Birth:
MM slash DD slash YYYY
Own? (Y/N):*
- Yes
- No
Value of Real Estate:
Mortgage balance ($):*
REQUIRED DOCUMENTS
Please upload a void cheque and quote below.
Documents
Drop files here or

Max. file size: 64 MB, Max. files: 6.
CONSENT AND SIGNATURE
The undersigned certifies that the information provided is true and accurate. By signing below, I / we agree that Pierquip Inc (And finance companies with whom it does business) gets any credit agency or any guarantor to the credit application with financial ties with the applicant any information required at all times and in connection with this credit application and consent to full disclosure of this information at any time.
Signature:*

LESSEE INFORMATION

Bank Information

SUPPLIER INFORMATION

EQUIPEMENT DESCRIPTION

PAYMENT TERMS

PERSONAL INFORMATION

REQUIRED DOCUMENTS

CONSENT AND SIGNATURE