A link to the Portable Document Format (PDF) of this form is provided below. The content of the form is duplicated in HTML following the PDF link.
Protected when completed
- Sole owner / Partnership / Association / Corporation
- Legal name
- Tel. no.
- Fax. no.
- Contact/Accounts payable
- Postal code
- Email address
- Federal / Provincial (Province)
- Registration no.
- Business no. (Gov't of Canada)
- Type of business
- In business since
- Yearly sales
- Monthly credit required
- Dealing in what province(s)?
- Previous/Other account no.
- Corporation officers or principal owners
- Position title
- Home address
- Tel. and fax
- Dealing with since
- Please list your main suppliers (at least three)
- Supplier's name
- Contact/Accounts receivable
- Tel. and fax
- Dealing with since
- Annual purchases ($)
What CBSA programs will you require? Please check all that apply
- Animal health and production
- Food safety investigation
- Dairy inspection program
- Egg inspection program
- Fair labelling practises program
- Feed inspection program
- Fertilizer program
- Fish, seafood, and production program
- Fresh, fruit and vegetable program
- Honey inspection program
- Meat hygiene program
- Plant health and production program
- Processed products program
- Seed program
I certify that the above information is correct and hereby apply for credit privileges from Her Majesty the Queen in right of Canada as represented by the Minister of Public Safety and Emergency Preparedness, hereinafter referred to as "Her Majesty". I have read the credit conditions on the back of this application and, if credit is granted to the applicant, the applicant agrees to abide by those conditions. I, the undersigned, authorize the Minister to make credit inquiries at any time in connection with the credit hereby applied for.
- Signature (Authorized Officer)
- Position title
For CBSA use only
- Grant credit / Deny credit
- Amount $
- Approved by
- Recommended by
- Account no.
Please return completed application to :
Canada Border Services Agency
Centre 400 Place D'Youville 2nd Floor
Montréal QC H2Y 2C2
Tel. 1-877-283-8703 ext. 8463
The conditions governing credit privileges provided by the Minister are:
- means the Minister of Public Safety and Emergency Preparedness or anyone authorized to act on the the Minister's behalf.
- means an applicant whose application for credit has been accepted.
1. The client shall pay Her Majesty for the amount of all goods or services received subject to terms of payment in effect on the date of the provision of the goods and services and as stated on an invoice or other written document specifically applicable to such provision which shall be provided by the Minister. Discounts will not be granted for prompt payment. Clients will be charged interest on any overdue amounts in accordance with agreements or as permitted by legislation/regulation.
2. An administrative fee will be applied to any account whose cheque or other payment instrument is not honoured by the financial institution on which it is drawn, for reasons of Non Sufficient Funds ("NSF") or otherwise.
3. Based on the results of the credit assessment and when contractual agreement permits, a security deposit may be requested from the client by the Minister whenever the client's future ability to discharge a debt in accordance with the payment terms is uncertain; and the client has a history of late payment accounts.
4. Credit privileges shall be withdrawn if it is discovered that the client has made a material false declaration or is otherwise in breach of imposed terms and conditions; or, the client's credit limit has been reached and a reassessment of the account does not support increasing the credit limit; the account remains unpaid 10 days after the Minister forwards a Final Notice to the client; and the Credit Manager obtains evidence that the client's financial viability is doubtful and there is no reasonable expectation of receiving payment for services requested. When credit privileges are withdrawn, the client shall pay in advance for any required goods and services.
5. If as a result of false information, a client obtained credit which would not have otherwise been given, full payment by the client shall be made immediately, regardless of any decisions regarding possible prosecution of the client.
6. Upon receipt of an official request from the Minister, the client shall provide a copy of the company's financial statements to the Minister.
7. Disputed charges or missing invoices must be reported to our office within 60 days of the date reflected on your monthly statement of account on which the invoice appears. Otherwise, our records will be considered accurate.
8. Credit balances are subject to application against the oldest outstanding charges, if not specified by the client within 60 days after notification.
9. The client shall notify the Minister of any change of address or ownership within five days from the date of those changes.
10. PROTECTED (when completed). Once completed, this form is protected pursuant to the Privacy Act. The information you provide on this form is collected under the authority of the Canadian Food Inspection Agency Act and will be used for the purpose of collecting inspection fees. This information may be shared with other government departments and agencies to enforce Canadian law. Details are available in the Treasury Board of Canada publication called Info Source. Info Source is available at public libraries, government public reading rooms, and on the Internet at: http://infosource .gc.ca.
11. Any information that is provided in this application, or in contacts with departmental officials relating to the granting of credit under this application, may be used by the Government of Canada or its agents, consistent with accepted commercial practices, and pertinent federal and provincial statutes and policy directives, to collect accounts. The collection of overdue amounts may involve the use of Private Collection Agencies and the provision to them of information provided by the client.
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