Fleet Account Application - FCA Group

Fleet Account Application

ACCOUNT APPLICATION AGREEMENT (To be completed by Applicant)

The Association agrees to communicate to its members that all vehicles purchased under the association program must remain with Canadian plates and in service in Canada for a minimum of 6 months or 12,000 km, whichever comes first from delivery date. Member companies who violate these terms may be excluded from taking advantage of the program. All vehicles covered by this agreement must remain with Canadian plates and in service in Canada for a minimum of 6 months or 12,000 km whichever comes first from delivery period. The undersigned agrees that, in the event that a vehicle(s) purchased under this agreement is put in service outside of Canada or registered with non-Canadian plates at any time prior to the expiry of 6 months of its purchase date, Chrysler Canada Inc. may forthwith, without notice:(i) cancel the delivery of any vehicles ordered but not yet delivered pursuant to this agreement; (ii) refuse to honour any further orders for vehicles made by the undersigned pursuant to this agreement; and/or terminate this agreement, and, in addition thereto, the undersigned, on demand by Chrysler Canada Inc., agrees to pay to Chrysler Canada Inc., as damages, an amout equal to the total amount of all program allowances, including basic allowances, granted in respect to such vehicle(s) under this agreement, forthwith upon demand. The undersigned hereby acknowledges that the aforesaid damages are a reasonable pre-estimate of the damages which would result from any such breach.

X

Authorized Signing Officer

Title

Date

1 COMPANY INFORMATION

COMPANY NAME______________________________________________________________________________________________________________________________

STREET_ ____________________________________________________________________________________________________________________________________

(See back of form for codes) P.O. BOX___________________________________________ CITY_ _________________________________________ ACCOUNT CATEGORY

PROVINCE__________________________________________ POSTAL CODE_ _________________________________ TELEPHONE NUMBER: ( )__________________________ FAX NUMBER:___________________________________

LIST NUMBER

Business Centre

HEAD OFFICE

or BRANCH OFFICE

IF BRANCH OFFICE, HEAD OFFICE FAN

GST #

LOTTERY LICENCE NUMBER IF APPLICABLE: PRIZE AWARD DATE:

2 CONTACT INFORMATION

Add

Revise

FIRST NAME

MIDDLE INITIAL

LAST NAME

Delete Title

English

Mailing Quantity

E-Mail:

French

Mailing Codes

(See table on reverse side)

3 FLEET VERIFICATION:

4 FLEET CONTENT:

GST #

Cars/Trucks

Chrysler ________

FordG.M.Other Imports

______

_______

_ _____

5 vehicle registrations

Trucks include all minivans/full-size/light trucks.

3 vehicle orders

Percentage Leased:_________ %

Leased From: _ _______________________________________________________

5 chrysler canada Inc. dealer or major leasing company APPLICATION:

NAME_____________________________________________________________________________ DEALER/LEASING CO. CODE NUMBER

APPLICATION SUBMITTED BY:

PHONE: ( )

FAX: (

)

(To be completed by applying Chrysler Canada Inc. Dealer/Leasing Company)

I have received the current Chrysler Canada Fleet program rules. I have conducted "due diligence" to ensure that this applicant is a bona fide Fleet account and does not participate in third-party sales for export. I have scrutinized at least five vehicle registrations or secured 3 orders or have recorded the GST# and I am satisfied that they are bona fide Fleet accounts. I have verified that the applicant's business operations and that a physical business location does exist and are consistent with this application for a Fleet Account.

Dealership/Leasing Co. Name

Code

Dealer Principal/Lease Co. Signing Authority

FAX TO appropriate business centre FAX OERasEteMrnAIL TO1-9F0L5E-E82T1I-N6F02O0RMATIWOeNstHeOrnTLIN1-E4:0830-209-897-209-423190 / fleeQtinufeob@ecc/1-514-630-2558

5013A001E

6

for office use only

NEW ACCOUNT APPLICATION APPROVALS

DATE: ----------------------------

A. Application Verified and Approved by: ____________________________________

Business Centre Fleet & Lease Manager's Signature

Assign Account Yes No

Representative Code

Date______________________

Suppress

Business Centre Fleet Office ? Please fax approved Application to Program Headquarters for processing.

B. Program Headquarters Use:

Eastern

Quebec/Atlantic

Western

National

Coordinator's Name:_ _______________________________ Date Approved/Assigned:_____________________________

Assigned Fleet Account No.

NEW ACCOUNT APPLICATION:

Sign, fax or mail completed form with proof of operation for five vehicles, three vehicle orders or valid GST # to the Regional Fleet/Lease Manager.

CODE A, H, N, G

DESCRIPTION

Account category

CODE

"COMMERCIAL" ACCOUNTS

B

DESCRIPTION GOVERNMENT ACCOUNTS

D

INDEPENDENT LEASING COMPANIES

F

INDEPENDENT DAILY

C

DEALERSHIP FAN

RENTAL COMPANIES

L*

Charitable organizations

UUTILITIES ACCOUNTS

PINDEPENDENT LEASING COMPANIES (internal use)

List Number

100 Commercial Company 200 Independent Leasing Company 400 Rental Car Company 600 Utility Company 700 Government Agency 800 Dealership Internal Lease Company 900 Chrysler Canada Inc. Fleet Personnel

Regional Number 21 Eastern 22 Quebec/Atlantic 25 Western

A. Car Buying Guide O. Truck Buying Guide C. All Other Mailings

MAIL CODES

D. Alternative Fuels E. No Mailings

*Organizations with Lottery numbers who wish to purchase vehicles for raffle purposes. Lottery licence number and date of prize award must be included in space provided on front of application. Fleet Account Number is valid for designated lottery only.

CONTACT THE FLEET INFO LINE AT 1-800-463-3600 IF YOU REQUIRE ASSISTANCE. E-mE-amil: afleile:tinflfoe@etcihnryfoca@ohmryFcaaxn: 1.c-8o0m0-870-4390

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