Credit Application

LEGAL COMPANY NAME:

TRADE NAME:

FORMER NAME (IF APPLICABLE):

TAX IDENTIFICATION NUMBER (TIN):

DUN & BRADSTREET (D-U-N-S) NUMBER:

STREET ADDRESS:

CITY:

PROVINCE / STATE:

POSTAL / ZIP CODE:

PHONE:

Please include area or country code

EMAIL:

WEBSITE

MAILING - STREET ADDRESS:

MAILING - CITY:

MAILING - PROVINCE / STATE:

MAILING - POSTAL / ZIP CODE:

INCORPORATION OFFICERS (NAME & TITLE):

YEARS OF BUSINESS:

PRODUCTS BEING SHIPPED:

TYPE OF SHIPMENT:

STORAGE GUARANTEE ONLY:

If yes, please register via Fastpass

NAME OF CPKC MARKETING & SALES REPRESENTATIVE:

FREQUENCY OF SHIPMENTS:

VOLUME OF SHIPMENTS:

ESTIMATED ANNUAL VALUE OF SHIPMENTS (DOLLAR VALUE IN USD):

TARGET DATE OF FIRST SHIPMENT:

ORIGIN COUNTRY (WHERE MAJORITY OF SHIPMENTS WILL ORIGINATE FROM): Canada United States

CREDIT LIMIT REQUESTED (DOLLAR VALUE IN USD):

INVOICE DELIVERY METHOD:

PRIMARY INVOICE RECIPIENT EMAIL:

PAYMENT METHOD:

ACCOUNTS PAYABLE - CONTACT NAME:

ACCOUNTS PAYABLE - CONTACT PHONE:

Please include area or country code

ACCOUNTS PAYABLE - CONTACT EMAIL:

FINANCE CONTROLLER - CONTACT NAME:

FINANCE CONTROLLER - CONTACT PHONE:

Please include area or country code

FINANCE CONTROLLER - CONTACT EMAIL:

OPERATION - CONTACT NAME:

OPERATION - CONTACT PHONE:

Please include area or country code

OPERATION - CONTACT EMAIL:

PARENT OR RELATED COMPANY INFORMATION (IF APPLICABLE):

GST TAX EXEMPTION ELIGIBILITY: Yes No

BANK - NAME:

BANK - STREET ADDRESS:

BANK - CITY:

BANK - PROVINCE / STATE:

BANK - POSTAL / ZIP CODE:

BANK - CONTACT NAME & TITLE:

BANK - PHONE NUMBER:

Please include area or country code

BANK - EMAIL ADDRESS:

TRADE REFERENCE - COMPANY NAME:

TRADE REFERENCE - PRIMARY CONTACT:

TRADE REFERENCE - PHONE NUMBER:

Please include area or country code

TRADE REFERENCE - EMAIL ADDRESS:

TRADE REFERENCE - COMPANY NAME:

TRADE REFERENCE - PRIMARY CONTACT:

TRADE REFERENCE - PHONE NUMBER:

Please include area or country code

TRADE REFERENCE - EMAIL ADDRESS:

TRADE REFERENCE - COMPANY NAME:

TRADE REFERENCE - PRIMARY CONTACT:

TRADE REFERENCE - PHONE NUMBER:

Please include area or country code

TRADE REFERENCE - EMAIL ADDRESS:

NAME OF PERSON - COMPLETING THIS FORM:

POSITION / TITLE OF PERSON COMPLETING THIS FORM: