APD Credit Application

Please Complete the Application Below

Required files are listed in * RED. Do NOT use AUTOFILL or AUTOCOMPLETE as that may interfere with the sending of your form.

Have you been in contact with an APD sales representative?

* Legal Name of Business

* Phone

* Contact First Name

* Contact Last Name

* Street Address

Address Line 2

* City

* Province/State

* Postal/ZIP Code

* Email Address

* I consent to receive the APD Newsletter by Email

Yes

Type of Business:

Partnership

Proprietorship

PST Number

* GST Number

* Operating Trade Name

* In Business Since

* # of Employees

* # of Service Bays

Company Web Site

Anticipated Annual Sales Volume

Principal 1

* Name

* Email

* Street Address

Address Line 2

* City

* Province/State

* Postal/ZIP Code

* Phone

Principal 2

Name

* Email

Street Address

Address Line 2

City

Province/State

Postal/ZIP Code

Phone

Business Location

* Business Location (owned or leased)

Landlord/Management Company (if leased)

* Business Phone

Banking Information

* Name of Bank

* Street Address

Address Line 2

* City

* Province/State

* Postal/ZIP Code

* Phone

* Has any principal(s) in the company claimed bankruptcy in the last 5 years?

Yes

If yes, please give particulars

References

* Trade Reference #1

Phone

* Email

* Trade Reference #2

Phone

* Email

* Trade Reference #3

Phone

* Email

Limit and Purchase Orders

* Credit Limit Requested ($)

Purchase Order Required?

Accounts Payable Contact Info

* Accounts Payable Contact

* Accounts Payable Email

* Accounts Payable Phone

TERMS and CONDITIONS of PAYMENT: Net 30 Days By clicking SUBMIT I/we hereby request credit accommodations from Automotive Parts Distributors (APD) and agree to pay for me/our purchases in accordance with the terms stated above. I/we further agree to pay a service charge on any amounts more than 30 days past due calculated at a rate of 24% per annum (2% per month). All parts and/or equipment remains the property of Automotive Parts Distributors (APD) until paid in full. I/we also hereby agree to pay APD all fees & expenses, including but not limited to all legal fees on a solicitor/client basis, incurred by APD in connection with the collection of all accounts due to APD by myself/ourselves. Automotive Parts Distributors has my/our consent to obtain credit reports about me/us from credit reporting agencies and other sources.

Thank you for your consideration, we will be in touch with you shortly.