North American Credit App

Vendor/Supplier Information


Applicant Information

Bank References

Legal Ownership Data

Proprietors, Corporate Officers, Partners, General Partner (if a person), LLC Managing Members (if a person) To help the government fight the funding of terrorism and money laundering activities, U.S. Federal law requires financial institutions to obtain, verify and record information that identifies each person (individuals or businesses) who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

Certification Information

Certification and Authorization of Individual(s) to Release Information: Each of the undersigned person(s), individually and on behalf of the above Applicant (collectively the “Signer”), hereby represents to Amsource Capital Ltd and its Assigns (collectively “ACL”) that (a) all information provided to ACL in connection with this credit application, including, without limitation, tax returns, financial statements, accountants’ statements and the information set forth above, is true and correct and (b) this credit application is made solely in connection with a commercial (and not a personal, family or household) transaction. Signer hereby authorizes ACL and any potential or actual assignees to obtain any business and/or personal financial information, from time to time, including, without limitation, information from any consumer reporting agency, credit bureau or other reporting source regarding Signer’s and/or Applicant’s credit history, for purposes of (i) evaluating this application, (ii) monitoring any and all leases, loans and other financial transactions entered into as a result of this application, (iii) extending, renewing or amending any such lease, loan or other contract, and/or (iv) evaluating any request by Signer or Applicant for additional credit in the future. Signer hereby authorizes and instructs any consumer reporting agency, financial institution and other persons or entities possessing information about Signer and/or Applicant to furnish ACL with all such information in response to an inquiry from ACL both now and at any time in the future.
Vendor/Supplier's Certification: By submitting this application to Amsource Capital Ltd and its Assigns (“ACL”), Vendor, by and through the individual employee or representative of Vendor who is transmitting this application to ACL, hereby represents and certifies to ACL that: (1) all information contained in the above referenced credit application is true and correct to the best of Vendor’s knowledge, (2) in the event Vendor later discovers that any of the above information is not correct, Vendor will submit to ACL a new application with the correct information, (3) Vendor is submitting the above credit application on behalf of the credit applicant named above (the “Applicant”) with the express permission, and at the express direction, of the Applicant for the purpose of obtaining commercial credit, (4) the Applicant and each person named as a principal in the application, if any (each, a “Principal”) has expressly authorized Vendor and any potential funding source (a “Funding Source”) to obtain business and personal credit, financial and other information about the Applicant and each such Principal, including but not limited to, information from banks, consumer reporting agencies, credit bureaus and other information sources (each, a “Reporting Source”), and (5) the Applicant and each such Principal, if any, has expressly authorized Vendor and any Funding Source to instruct any and all Reporting Sources to furnish directly to such Funding Source all such information about the Applicant and each Principal.

Besides white, what color is the Amsource Capital Logo?