Credit Application CA - CDW

20 Carlson Court, Ste. 300 Etobicoke, Ontario M9W 7K6 cdw.ca 800.387.2173

CREDIT APPLICATION

SALES TAX EXEMPT NOTIFICATION

If purchases from CDW will be exempt from provincial sales tax, please provide tax exemption certification FOR ALL APPLICABLE PROVINCES to ensure proper invoicing.

BUSINESS CONTACT INFORMATION

Company Name:

DBA (or formerly known as):

Company Website:

Federal Tax Id Number:

Ticker Symbol (if publicly traded) : A/P Contact Name:

Year Started: A/P Phone:

A/P E-mail address:

Dun & Bradstreet Number:

Company Billing Address (city,province,postal code) :

Previous Address (city,province,postal code ):

Company Physical Address:

Source of Venture Capital / Private Equity (if applicable) : Contact Person:

Phone #:

Credit Line Requested: Primary Bank Name:

Website:

$1-$15k $16-$25k

$26-$50k $51-$100k Over $100k (financials required)

BANKING RELATIONSHIPS

Account and Transit Numbers (required to process) :

Name: Address:

Bank Address (city,province,postal code) :

Nature of Accounts (operating accounts, lines of credit, savings accounts. If a ZBA or

Sweep acct list funding source):

Bank Contact: Secondary Bank Name:

Bank Address (city,province,postal code) :

Phone: Account Numbers (required to process) :

Nature of Accounts (operating accounts, lines of credit, savings accounts. If a ZBA or

Sweep acct list funding source):

Bank Contact:

Phone:

Signature:

Agreement

I / We agree to Net 30 Payment Terms with CDW I hereby authorize release any and all banking information to CDW or its assignees

Signature (An authorized bank signer is required)

Print Name:

Date:

Title:

EX DT

Application Must Be Complete

March 2009

CONSENT FORM

I/we hereby take notice that Quality Credit Services Limited will be using the attached and signed credit application to obtain bank reference information, including account balances and other credit information on behalf of CDW Canada Inc. and may be referring to a consumer/commercial credit report respecting us/me containing personal information and/or credit information. In connection with my/our application for credit, I/we hereby take notice that Quality Credit Services Limited will have access to this application which may contain personal and identifying information as defined in Canadian Privacy Legislation.

Date: ____________________________________________ Signature: ________________________________________ Name (print): ______________________________________

EX DT

Application Must Be Complete

Dec 2008 rev2jh

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