Confidential Credit Application & Agreement

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Contacts

Accounts Payable

Name *

Email Address *

Purchasing

Name *

Email Address *

Finance / CEO

Name *

Email Address *

Other

Do you require a purchase order? *

Yes No

Does your company pay by EFT? *

Yes No

(electronic funds transfer)

Credit Limit *

Annual Rental Volume *

# of Employees *

Business Classification & Individuals Involved

Business Classification *

Limited Partnership Individual or Sole Proprietorship

Bank Reference

Your Bank *

Account Number *

Phone Number *

Contact Name *

Email Address *

Major Suppliers / Trades (Rental Companies if possible)

* Minimum One Supplier Required

Supplier #1

Company Name *

Phone Number *

Contact Name *

Email Address *

Fax Number

Supplier #2

Company Name

Phone Number

Contact Name

Email Address

Fax Number

Supplier #3

Company Name

Phone Number

Contact Name

Email Address

Fax Number

Insurance Requirements

Insured: the name, address, policy number and expiry date.
General Liability: minimum of $ 1,000,000.00 per occurrence for bodily injury and property damage.
Rental Equipment Coverage: replacement value of the rented equipment without deduction for depreciation and acceptable to Cooper Equipment Rentals Ltd.
Additional information: Cooper Equipment Rentals Ltd. to be added as “Additional Insured” under the general liability policy and “Loss Payee” for material loss under the equipment coverage policy.
Notice of cancellation: Cooper Equipment Rentals Ltd. to be notified 30 days prior to the cancellation of all such insurance coverage above.

Insurance Company *

Policy Number *

Name of Insured *

Expiry Date *

Agent's Name *

Agent's Phone Number *

Email Address *

Insurance Certificate

File must be less than 5MB in size, in either PDF, JPG, GIF or PNG format. You may also email your certificate to [email protected]. Please include your company’s name in the message.

Cooper Protection Plan

Cooper Equipment Rentals offers a comprehensive loss and damage coverage through the Cooper Protection Plan. Applicant acknowledges having read and understood the coverage and conditions of the Cooper Protection Plan as outlined in this document and has decided as follows:

I have read and fully understand the Cooper Protection Plan.

Do you wish to be covered by CPP?

Yes No

The Undersigned:

Acknowledges and agrees to having read, understood and accepted the terms and conditions of this Credit Application at the bottom of the document, and also the General Terms and Conditions stipulated in all other documents including but not limited to invoices, rental contracts, purchase agreements and also those stipulated in the Cooper Protection Plan.
Agrees to abide by the terms and conditions set out in this application for credit and has the authority to bind the Applicant.
Hereby represents that he or she is fully authorized to submit the application for credit or account on behalf of the Applicant.

Legal Company Name *

Name *

Title *

Terms and Conditions

THE UNDERSIGNED, MANDATED AND FULLY AUTHORIZED BY APPLICANT, AGREES, CONSENTS AND UNDERSTANDS:

Terms are Net 30 days, except for equipment sales which are stated on the sales invoice or sales contract.
Service Charges at the rate of Two percent (2%) per month or Twenty-four percent (24%) per annum, as set out on Lessor’s invoices will be applied to all past due Rentals and Purchases.
All NSF or returned cheques will be subject to a service charge equivalent to the fee charged by the Canadian Imperial Bank of Commerce for such event, plus a premium of twenty dollars ($20.00).
Applicant to bear all cost incurred by Lessor in collecting any unpaid amounts including but not limited, to collection agencies and lawyers’ fees.
The charge account privileges may be cancelled and withdrawn at any time, at the sole discretion of Lessor, without forfeiting any amount due, or pardoning any debt of the Applicant.
The Applicant will be held responsible and fully liable for losses and damages to the equipment while under its custody care and control, and the appraisal for any such loss or damages shall be based on the replacement cost of new equipment at time of loss or damage, with no deduction for depreciation.
That based on the Applicant’s credit worthiness, as per the Lessor’s own selection criteria, a personal or third party guaranty may be required by Lessor to open a charge account as requested.
Domicile is elected in the judicial region of Peel in the province of Ontario where this document is deemed to have been signed.

IN ADDITION, THE UNDERSIGNED, MANDATED AND FULLY AUTHORIZED BY APPLICANT, CERTIFIES THAT:

The information contained herein is correct and authorizes and consents to the receipt and exchange of any credit information by the Lessor including the exchange of credit information concerning the Applicant with any credit reporting agency or any person or corporation with whom the Applicant has or proposes to have financial relations.

I have read and fully understand the Terms and Conditions.

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Confidential Credit Application & Agreement