Financing

Please don't hesitate to complete and send us this electronic form. For all additional information requests, you can contact us by phone at (819) 396-2850, Extension 138.

Supplier		Supplier No.	Contact Person / Function	Telephone	Fax

Name	Email
	Contact person / Function

Customer Address (Headquarter)	City	Province	Postal code

Telephone	Cell phone	Fax	Business sector	Years in business

TRANSACTION parameters

Equipment description	For internal use
	Equipment cost :
	Minus exchange :
	Plus B/O or T/U :

Equipment	Equipment cost	Term (O/A / Full)	Net rental payment	Deposit	Balance	No. T/U or B/O
New

SHAREHOLDER / OWNER INFORMATION

(1) Last name	(1) First name	(1) Initial	S.I.N. (Optional)	Birth date (dd/mm/yyyy)

Personal address	City	Province	Postal code

Owner	Lessee	Other	Please indicate if other	Monthly revenue	Comments:

(2) Last name	(2) First name	(2) Initial	S.I.N (optional)	Birth date (dd/mm/yyyy)

Personal address	City	Province	Postal code

Owner	Lessee	Other	Please indicate if other	Monthly revenue	Comments:

You, the undersigned, accept that Tremzac collect, use and communicate personal and commercial information on and about you. This information can be gathered from and communicated to agents, affiliates, third-party suppliers, credit-assessment agencies, accounting agencies, other credit distributors, any person with whom you have or intend to have financial relations, as well as third parties who wish to get involved in granting a loan, a lease or other investment, for which your personal or business information are relevant or which are required to assess reasonable risk or diligence as part of a financial transaction or potential financial transaction. You also authorise anyone we could contact to that end to supply us with such information. You recognize that we could forward your information to countries around the world where we do business. Correspondingly, your information could be accessible to regulatory organisations in compliance with the laws in these jurisdictions. We reserve the right to collect, use and communicate with your social insurance number and other identification information to verify or report information about your ability to pay to credit assessment agencies or accounting agencies, as well as to confirm your identify.