Home Lumber and Building Supplies - Victoria BC

LAST NAME		FIRST NAME	SOCIAL INSURANCE NUMBER
STREET ADDRESS			HOME TELEPHONE
			BUSINESS TELEPHONE
			CELLULAR TELEPHONE
CITY		PROVINCE
DATE OF BIRTH		POSTAL CODE
MAILING ADDRESS IF DIFFERENT FROM ABOVE			EMAIL ADDRESS
PREVIOUS ADDRESS			CITY	POSTAL CODE
MONTHLY INCOME FROM EMPLOYMENT		SPOUSE OR OTHER INCOME		NUMBER OF DEPENDANTS
EMPLOYER	ADDRESS		POSITION	HOW LONG
PREVIOUS EMPLOYER	ADDRESS		POSITION	HOW LONG
SPOUSE'S EMPLOYER	ADDRESS		POSITION	HOW LONG
CURRENT OBLIGATIONS CREDITORS		ORIGINAL AMOUNT	BALANCE DUE	MONTHLY PAYMENTS



HOME RENTED- MONTHLY RENT $__________________ OWNED BY SELF, MARKET VALUE $__________________ OWNED BYSPOUSE OR OTHER PERSON. MARKET VALUE $__________________ BALANCE DUE $ _______________ MORTGAGE HELD BY ______________________
AUTOMOBILE
YEAR	MAKE	AMOUNT OWING $	VALUE $
BANK	ADDRESS	SAVINGS ACCOUNT	CURRENT ACCOUNT

REFERENCES WHERE CHARGE ACCOUNTS OPERATED
1.		ADDRESS
2.		ADDRESS
3.		ADDRESS
STREET ADDRESS OF PREMISES UNDER CONSTRUCTION		CITY
LEGAL DESCRIPTION OF CONSTRUCTION PROJECT
LOT	PLAN	SECTION		DISTRICT
DETAILS OF FINANCING OF CONSTRUCTION PROJECT
LENDER		AMOUNT		TYPE
The above information is for the purpose of obtaining credit and is warranted as being true and accurate I request that you provide credit to the undersigned for goods and/or services and in consideration of your providing the same I agree to pay all of your costs, charges and expenses by the 15th of the month immediately following the delivery of any such goods and/or services (the "Payment Date"). If payment is not made on the Payment Date then the amount unpaid shall bear compound interest at a rate of 2% per month (26.82% per annum) from the payment date until paid in full. I further agree to pay all costs, charges and expenses of, and incidental thereto, proceedings taken to collect any monies due and unpaid herein including costs on a solicitor/client basis. Either party may terminate this arrangement forthwith upon written notice whereupon all balances, including interests and costs, shall become immediately due and payable. Notwithstanding anything set out above, Home Lumber & Building Supplies may, in their sole discretion, refuse to deliver goods and/or services at any time or limit the amount of credit to be extended from time to time. I hereby authorize Home Lumber & Building Supplies to obtain such credit reports or other information as may be deemed necessary in connection with the establishment or maintenance of this credit account or for any other direct business requirement. I acknowledge receipt of a copy of this document.
Date		Signature of Applicant

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HOME LUMBER & BUILDING SUPPLIES Division of Jawl Industries Ltd. 470 Ardersier Rd., Victoria. B.C. V8Z 7H7	Sales: Fax: Admin: Fax:	475-3374 475-3394 475-0333 475-3364
Email: info@homelumber.net Website: www.homelumber.net	Toll Free: 1-877-933-3374