Equipment Credit Application

Meridian OneCap Credit Corp.

Suite 1500 – 4710 Kingsway, Burnaby, BC V5H 4M2
Telephone: (604) 646-2200 Fax: (604) 687-7091
GST-HST Registration # 773091293 RT 0001
QST Registration # 1223770556 TQ0001

- CUSTOMER INFORMATION
- Customer’s Full Legal Name – Include Trade Name*
- Email Address*
- Contact Name & Title*
- Customer’s Address (Head Office)*
- Telephone Number*
- Fax Number*
- Cell Number*
- Type of Business / SIC*
- Years in Business*
- PROPOSED TRANSACTION DETAILS
- Vendor Name*
- Contact Name & Title*
- Telephone Number*
- Fax Number*
- General Equipment Description:*
- Equipment*
  - NEW
  - USED
- Equipment Cost*
- Term to P/O-EOL*
- Regular Rental*
- Down Payment*
- Residual*
- Trade-up or Buyout #*
- PRINCIPAL SHAREHOLDERS INFORMATION
- (1) Last Name/First Name/MI*
- (1) Home Address*
  City State / Province / Region ZIP / Postal Code
- S.I.N. (Optional)
- Date of Birth*
  MM slash DD slash YYYY
- Telephone Number*
- Mobile Number*
- *
  - OWN
  - RENT
  - OTHER
- Other-Please Specify
- Monthly Income*
- Comments
- (2) Last Name/First Name/MI
- (2) Home Address
  City State / Province / Region ZIP / Postal Code
- S.I.N. (Optional)
- Date of Birth
  MM slash DD slash YYYY
- Telephone Number
- Mobile Number
- - OWN
  - RENT
  - OTHER
- Other-Please Specify
- Monthly Income
- Comments
- *
  Privacy: We the undersigned hereby authorize Meridian OneCap Credit Corp. (Meridian OneCap) in connection with this Credit Application to collect, use, and disclose certain personal and business information from and about us (“Information”). Meridian OneCap may collect Information from and/or disclose Information to its agents, affiliates, third party service providers, credit bureaus, credit reporting agencies, other credit grantors, financing partners, and/or any person we have or propose to have financial relations with as well as third parties who wish to become involved in the syndication of a loan, lease, or other investment in which Information is relevant, or who are involved in risk assessment or due diligence in the context of a financial transaction or proposed financial transaction. We also authorize any person whom Meridian OneCap may contact in this regard to provide Information to Meridian OneCap. We acknowledge that Meridian OneCap may transfer to, and store Information in, jurisdictions where Meridian OneCap does business. As a result, Information may be accessible to regulatory authorities in accordance with the laws of these jurisdictions. Meridian OneCap may collect, use, and disclose our Social Insurance Numbers or other personal identifiers to verify and report credit information to credit bureaus or credit reporting agencies as well as to confirm our identities. Meridian OneCap may give Information about us to Meridian OneCap’s partners so that these companies may tell us directly about their products and services. We understand that our consent to this is not a condition of doing business with Meridian OneCap and we may withdraw it at any time. By choosing to provide Meridian OneCap with Information, we are consenting to its use in accordance with the Privacy Act which we may view and obtain at any time at http://laws-lois.justice.gc.ca/eng/acts/P-21/index.html.
- Signature (1)*
- Signature (2)
- CAPTCHA
Name
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Meridian OneCap Credit Corp.

CUSTOMER INFORMATION

PROPOSED TRANSACTION DETAILS

PRINCIPAL SHAREHOLDERS INFORMATION