Employee Purchase Program Pre-Authorization Form

Part 1
Employee Name*
First Last
Employee ID*
Department*
Email*
Phone (local)*
Part 2
Program Type*
- Bicycles, electric bicycles, pannier bags, trailers, safety and accessories, maintenance, and security products (BIKE)
- Desktops, laptops, tablets and related accessories (TECH)
Vendor*
Purchase Price * Pre-Tax*
Please enter a number less than or equal to 5000.
HST*
Total Purchase*
Term Required*
(Must be 1, 2, or 3 years)
Attach the Quote or Pre-Sales Order You've Received Here*
Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, htm, html, Max. file size: 15 MB.
Employees may utilize one or both programs, however only one loan is allowable, per program, per employee to a maximum of $5,000 until paid in full. The maximum combined employee loan balance shall not exceed $7,000.
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Part 1