FLEET IDENTIFICATION NUMBER

Fairley and Stevens Ford Lincoln     _________ New Application 

Toll Free: 800-463-1220                        __________Renewal 

Fax: 902-468-7270                 Existing FIN:_____________ 

1.REQUIRED INFORMATION FOR ALL APPLICATIONS AND RENEWALS 

Fleet Customer Legal Name:______________________________________________ 

Business Operating Name: _______________________________________________

 GST # __________ # Of  years in Business: _____  Type of Business: _____________ 

 Street Address: ______________________City:_________Province_______________

Postal Code:_________________________  

Telephone: ___________Fax:___________

Company Website:___________________

Authorized Decision Person:______________________

Title:____________________

Authorized Decision Person Email:_________________________________________ 

FIVE (5) Valid vehicle registrations and / or copies for the new Ford vehicle orders are included with this application check here (  ) FLEET SIZE

 Vehicles to be purchases in the next 12 months:

Types of Vehicle (Models) that will be purchased: 

Car _________________                            Truck________________

1.___________________ 

2.___________________

3.___________________

4.__________________

5.__________________

6.___________________ 

 2. COMMERCIAL INFORMATION/SUPPORTING DOCUMENTATION REQUIRED

(     ) For incorporated companies, articles of incorporation including a list of corporate officers 

3. GOVERNMENT INFORMATION

Type of Agency___ Federal_____Provincial_____Municipal______ Other (please specify)______ 

4.  LEASING INFORMATION / SUPPORTING DOUCMENTATION REQUIRED

 ___Dealer ____ Non-Dealer 

Method of Disposal   ________  Dealer License # (if applicable):_________________  

 5. RENTAL INFORMATION / SUPPORTING DOCUMENTATION REQUIRED

 (    ) Independent Operator                 (    ) Franchisee:_________________

If Franchise Copy of Franchise Agreement (   ) 

Method of Disposal:_____________

Dealer License # (if applicable)_________________ 

6. DEALERSHIP INFORMATION (TO BE COMPLETED BY DEALER) 

Byron Feltmate

Dealership Representative Signature: ____________________________________

 (    ) Dealer Visited Location (Required for Rental & Leasing FINs) 

 7.CUSTOMER APPLICATION AGREEMENT  

Fleet Customer Application Terms and Conditions 

Ford Motor Company of Canada, Limited (“Ford of Canada”) provides to Ford of Canada Dealers, as developed from time to time,  Fleet incentives and other Fleet benefits for the benefit of valid holders of a Ford of Canada Fleet Identification Number (FIN).   Vehicles purchased utilizing a Ford of Canada FIN are subject to the following provisions:1. Vehicles must be operated (remain licensed and registered) in Canada according to Ford of Canada program requirements.  These program requirements are currently a minimum period of 6 months and a minimum of 15,000 kilometers from the original delivery date or first use in Canada, whichever occurs first;2. Fleet Customers must be residents of Canada and;3. The vehicles must not be purchased for the purpose of reselling to another purchaser.

Fleet Customer Application Agreement

The undersigned Fleet Customer, has read and understood the conditions 1, 2 & 3 as outlined under the “Fleet Customer Application Terms and Conditions” section, and agrees that the Fleet Customer will abide by these terms and conditions.  The Fleet Customer acknowledges that in the event the Fleet Customer contravenes any of the terms and conditions contained herein, Ford of Canada shall charge back the Fleet Customer any Fleet incentives extended by Ford of Canada for all vehicles involved.Ford of Canada shall at all times have the right, in it’s sole discretion, to amend or revoke the FIN Terms and Conditions, cancel the Fleet Customer’s FIN and/or amend or revoke any of the Fleet incentives and benefits contemplated herein without notice or obligation.

Fleet Customer Legal Name (Printed)     _____________________________     Date:  _________________

I have the authority to bind the Fleet Customer _________________________  Title:___________________

Please print this page complete with the required information and fax to our Business Office at 902-468-7270