I hereby certify that the information contained herein is complete and accurate. I/We hereby authorize the bank and trade references listed in this credit application to release necessary information to ComfeMed to investigate Applicant’s credit and financial responsibility.

I certify on behalf of the Applicant that I have read and understand the “Terms and Conditions” page on http://www.comfemed.ca , and failure to abide by the terms and conditions may result in interest and/or late fees being assessed to Applicant’s account.