PREVIOUS ADDRESS (IF LESS THAN TWO YEARS)
STREET: CITY: POSTAL CODE:
PST #: GST #:
TYPE OF BUSINESS: HOW LONG IN BUSINESS: TAX NUMBERS:
BANKING INFORMATION
CREDIT REFERENCES
I HEREBY AUTHORIZE D.GOERTZEN EQUIPMENT LIMITED TO VERIFY ANY OF THE ABOVE INFORMATION FOR THE PURPOSE OF ESTABLISHING MY CREDIT APPLICATION.
