Thank you for selecting us as your preferred Alberta Registries service provider.  If you haven't already, please read and familiarize yourself with our account terms and conditions page.

Take a moment to review this form before you start to fill it in.  We've kept it short, but you may need to gather phone numbers or ask about volumes.  If you're unsure about some things, leave them blank for now.

NOTE:  Please list yourself as the first company contact person.

BUSINESS INFORMATION
Name of Business*
Operating As
-(if different)
Address*
City* Prov:
Postal Code*
Website URL
Business Structure* Corporation
 Partnership
 Proprietorship
 Subsidiary of
In business Since* yyyy
No. of employees*
Type of Business*
 

TRANSACTIONS

Projected
Monthly
Transaction
Volumes

 Motor Vehicles
 Personal Property
 Land Titles
 Corporate Registry
 Vital Statistics
 

CONTACTS
Your Name*
Your Position*
E-mail address*
Your Phone* EXT:

 
Name
Position
E-mail address
Phone EXT:

 
Name
Position
E-mail address
Phone EXT:
 

BANKING INFORMATION
Bank Name*
Branch*
Address*
Contact*
Phone* EXT:
 

TRADE REFERENCES
Firm Name*
Contact Name*
Phone* EXT:
Account since* yyyy

 
Firm Name*
Contact Name*
Phone* EXT:
Account Since* yyyy

 
Firm Name*
Contact Name*
Phone* EXT:
Account Since* yyyy
 

COMMENTS
 

CERTIFICATION
By submitting this application, I hereby certify that the information in this application is accurate and correct.

The information is for use by Country Hills PLATES Inc. in determining the amount and conditions of credit to be extended.  I understand that other sources of credit information may be used in making this determination.  Further, I hereby authorize the bank and trade references listed in this application to release the information necessary to assist Country Hills PLATES Inc. in establishing a line of credit.

I am the person named above as the first company contact and I am authorized to submit this application on behalf of the company.

* denotes required fields