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** Data required in all fields.

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Type of Account applying for:  
Requesting $
Company Name:  
Other Trade Name:
Address: Street
City Prov. Postal Code
Phone no. Fax no.
PST no. GST no.
Shipping Address:
Email Address:

 

Company Profile
Ownership:
  If Subsidiary is chosen, please enter the parent company name:

Business Type:
Number of Years in Business:
Attached Recent Financial Statement (Audited Perferred)

 

Bank Information
Bank Name:
Address: Street
City: Prov. Postal Code
Phone No. Fax no.
Account Number:
Loan Number:

 

Credit Reference

Name:
Phone No:

Name:

Phone No:

Name:

Phone No:


Key Company Personnel
State full names of company principals, home address and titles.

Name: Title:
Address:
Name: Title:
Address:


Key Company Contacts

Accounts Payable
Purchasing Manager

 

Agreement

The undersigned certifies that the information supplied in this credit application to be true and affirms that any credit terms are extended upon the basis of such information. The undersigned consents to the obtaining of credit information as may be required at any time in connection with the credit hereby applied for or any renewal or extension thereof and the disclosure of any credit information concerning the undersigned to any credit reporting agency or to any person with whom the undersigned has or proposed to have financial relations.

The undersigned hereby grants to MicroGram Systems (Canada) Ltd. ("MicroGram") a security interest in all goods sold by MicroGram to the undersigned and the proceeds thereof (the "Collateral") to secure payment of all debts and liabilities, present or future, direct or indirect, absolute or contingent, matured or not at any time owing by the undersigned to MicroGram (the "Obligations"). Default in payment or performance of any of the Obligations or default under any agreement or document evidencing any of the Obligations shall be a default hereunder whereupon all Obligations shall be due and payable forthwith without notice to the undersigned, and MicroGram shall thereupon have the rights and remedies of a secured party under the Personal Property Security Act, 1989. The Debtor agrees that all proceeds of the Collateral shall be held in trust by Debtor for MicroGram.

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