Dignity Personal Credit Application Form – Fill Out and Use This PDF

900 Magnetic Drive

	Toronto, Ontario, M3J 2C4	Tel: (416) 398-2222
		Fax: 1 (866) 849-5869
	Email: info@dignitytransportation.com	Toll Free: 1 (866) 398-2109
	Website: www.dignitytransportation.com

PERSONAL CREDIT APPLICATION

Billing Information

Name:				S.I.N.
Address		City / Province
Postal Code	E-Mail Address		E-Mail Invoices and Back-up
						Yes		No

Passenger Information (if different from above)

	Name:		Email Address:
	Address				City / Province
	Home Telephone Number	Business Telephone Number		Mobile Number:

Employer’s Information

Employer		Employer’s Address			Employer’s Telephone Number
Current Position	Years in Current Position		Years with Company	Annual Salary

Bank Information

Address

In applying for credit with Dignity Transportation Inc., the undersigned consents to Dignity Transportation Inc. obtaining from, exchanging with or disclosing to a third party all information concerning the applicant for the purpose of ensuring the accuracy of this information and conducting investigations.

TERMS AND CONDITIONS

1)All pricing will be as per the most recently published Dignity Transportation Inc price list.

2)A gas surcharge may be charged as per said price list.

3)All changes or cancellations of orders must be made through the dispatcher of Dignity Transportation Inc.

4)No show and cancelled at the door will be charged as per Dignity Transportation Inc policy.

5)

6)No account may be cancelled retroactively.

7)If there is a dispute on a charge, it must be forwarded in writing within 15 days of date of invoice or it will not be accepted and the full charge will be due and payable.

8)Dignity Transportation Inc will measure all distances using appropriate computer software and charge accordingly.

9)Terms of payment are net 15 days from date of invoice and an overdue fee of 2% per month will be charged on late payments.

10)From time to time due to unusual weather or road conditions the vehicle may be late and Dignity Transportation Inc does not accept any responsibility in late arrival or no show fees administered to the client.

11)Orders will only be accepted by the authorized person or persons. These orders may be emailed, faxed or phoned in.

12)Should legal action be required to collect an over due account, the insurance company is responsible for said expenses.

The Undersigned hereby authorizes Dignity Transportation Inc. to collect any overdue balance on my account by charging one of the above credit cards.

Applicant’s Signature