LeasePlan Credit Application

Business Information

Legal Business Name *

Doing Business As

Business Street Address *

Address Line 2

City *

Province *

Postal Code *

First Name *

Last Name *

Email *

Business Phone *

Business Fax

Financial Statement Available *

yes

How long at the current address * Years

Month * Month

Billing Information

Same as Business Address

Billing Contact First Name

Billing Contact Last Name

Billing Street Address

Address Line 2

City

Postal Code

Province

Billing Phone

Billing Fax

Billing Email

Additional Information

GST/HST number *

Enter your company's GST or HST number (#########)

Legal Structure *

Number of Cards Requested *

(1 card per active unit required)

Estimated Monthly Tire & Service Expenses * $

Years Incorporated *

Bank Information

Please provide the following Bank and Account information for the primary Financial Institution used by your business. This information will be used for Pre-Authorized Debit payments (PAD).

Name on Bank Account *

Bank Account Number *

Bank Transit *

Bank Name and Branch *

Bank Street Address *

City *

Postal Code *

Province *

Bank Phone *

Bank Fax

Commercial Credit References

Please provide the two Trade References for your company below.

Credit Reference 1

Commercial Name *

First Name *

Last Name *

Address *

Address Line 2

City *

Postal Code *

Province *

Phone *

Credit Reference 2

Commercial Name *

First Name *

Last Name *

Address *

Address Line 2

City *

Postal Code *

Province *

Phone *

Personal Credit Information

In order to process your application, we will need to obtain a consumer credit report on a title-authorized representative for your company; such as President/Chairman, Partner, Vice President, Owner or Treasurer/Financial Officer. The Personal credit history of the person provided below will be used in making a credit decision.

First Name *

Last Name *

Home Address *

Address Line 2

City

Postal Code *

Province *

Phone *

Date of Birth *

Terms and Conditions

The Customer applies to LeasePlan Canada. (LPCA) for the LeasePlan Fleet Management Card. The Customer consents to LPCA’ collection, use and sharing of the personal information (the “Cardholder Information”) provided in this Application or complied internally by either LPCA or its third party service providers for the purpose of offering the Customer a LPCA Fleet Management Card. Pursuant to the LPCA Fleet Management Card, the Customer may charge goods and services up to the credit limit set by LPCA and must pay the full balance as shown on each monthly billing statement, according to the general terms and conditions of the agreement (the “Cardholder Agreement”) relating to the LPCA Fleet Management Card, a copy of which will be sent to the Customer with its credit card upon approval of this Application: and upon approval of this Application, the Customer agrees with LPCA to abide by and be bound by the terms and conditions set out in the Agreement. By signing this Application the Customer represents and warrants that: (a) it is a valid business entity or a self-employed professional or business person, and duly registered as such under all applicable laws; (b) all purchases made on the Account, if approved, will be for business purposes and shall not include personal, family, or household use; (c) the individual signing the Application is an authorized representative of the business with authority to enter into contractual agreements; and (d) the Cardholder Information is complete and accurate. LPCA will, from time to time, (i) use or disclose the Cardholder Information, and information obtained subsequently from any source with the Customer’s consent (collectively the “Information”) to obtain credit reports from credit reporting agencies and to contact credit references and other sources disclosed herein as part of its assessment of the Information; and (ii) may transfer the Information to a third party as part of a transfer of all or part of LPCA’ charge card or credit card business (collectively the “Purposes”). LPCA may provide some or all of the Information to third party service providers who process the Information only in furtherance of the Purposes or in accordance with applicable law. For any questions regarding the Information or Purposes, please consult our Privacy Policy at leaseplan.com/en-ca/privacy-statement/ or call 1-877-728-8677. The Customer consents to LPCA’ use of the Information for the Purposes or in accordance with applicable law. Customer also understands that credit on the LPCA Fleet Management Card, once approved, will be extended by LPCA, and that there will be no-binding contract between the Customer and LPCA until LPCA approves and accepts this Application. All Applicants are deemed to be authorized signatories of the Customer and acknowledge and agree that they are responsible for all purchases on the LPCA Fleet Management Card made by the Customer.

Authorized Signature

Note: By submitting this form, the Applicant agrees that: The information provided is true and accurate. It has been provided for the purposes of review of this application and, if said application is accepted, for the subsequent handling of the Applicant’s client file (credit-billing-collection). For these purposes, the Applicant authorizes LeasePlan Canada. (LPCA) to carry out, now and at any time in the future, any and all of the usual credit investigations with any third party, and also agrees that LPCA may request, obtain and communicate to any such third party, any personal information regarding the Applicant. The Applicant furthermore agrees that LPCA may provide access to and communicate personal information contained in the Applicant’s client file to any credit reporting agency, person or firm with whom the Applicant has or did have financial relations. The Applicant hereby agrees to promptly inform LPCA of any change with respect to the personal information provided herein and the Applicant further understands that LPCA reserves the right to apply credit restrictions at any time. The Applicant accepts and agrees to be bound by the terms and conditions governing the use of LPCA Fleet Management Card issued from time to time by LPCA for any and all purchases made with the card(s) at all participating retailers. The personal information contained herein will be made accessible to employees, mandatories or agents of LPCA when necessary for the performance of their duties, and a client file will be held at LPCA’ offices situated at 125 Commerce Valley Drive W. Suite 801, Markham Ontario L3T 7W4. The Applicant acknowledges and understands that he/she has a right of access to the personal information contained in their file and a right of rectification. The Applicant is duly authorized to complete the application on behalf of this corporation, partnership or proprietorship and confirms that these cards will be used for business purposes.

By signing this application I give permission to LeasePlan Canada to send marketing communications

Signer's First Name *

Signer's Last Name *

Title *

Signer's Phone *

Signer's Email *

Your Signature *

By signing this field you have provided your authorized signature to this LeasePlan Canada Fleet Management Card Credit Application request

I have read and accept the Terms and Conditions above *

I have read and accept the Terms and Conditions above

FAQ:

How do I pay for Tires and Maintenance/Service related items?

You will be provided a LeasePlan Canada Maintenance Fleet Card that you will present to the tire/maintenance facility. This card is used as a purchasing instrument for all Tire and Maintenance/Service related items.

Where do I take my vehicles for tires and services?

You will have access to over 15,000 National Account and Independent Garages that have been pre-approved to accept the LeasePlan Canada Maintenance Fleet Card. A listing of the vendors can be found at https://www.fossnational.com/leaseplan/maintenance-network

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LeasePlan Credit Application

How do I pay for Tires and Maintenance/Service related items?

Where do I take my vehicles for tires and services?

How is the vendor authorized to proceed with tire and maintenance/service related items?

How will I be invoiced?

What type of pricing can I expect using your program?

How do I pay for Tires and Maintenance/Service related items?

Where do I take my vehicles for tires and services?

How is the vendor authorized to proceed with tire and maintenance/service related items?

How will I be invoiced?

What type of pricing can I expect using your program?