1. Print this application form

2.  Fill it out

3. Fax or mail this application form to us 

APPLICATION FOR CREDIT PRIVILEGES

LEGAL COMPANY

 NAME:                                                                                                                     

Address                                                                                                                 

Contact:                                                                      Phone-1                            

Email Address                                                              Phone-2                               

Nature of Business                                                                                              

Fax                                             

Yearly Purchases: $                                     Credit Limit Required: $                          

Ownership Information

    Name                                          Address                                Position

1.                                                                                                                         

2.                                                                                                       ___________

3.                                                                                                       ___________

PST License:                                            GST No.:                                          

                  Please supply Certification of Exemption if Applicable

Bank:                                                              Contact:                                       

Address                                                                                                               

Account Number:                                                                                        

 Phone                                                                 

CONSENT:

          I/We consent to the obtaining information as required from time to time in connection with credit applied for or any renewal or extension thereof, and to the disclosure of information to any credit reporting agency by any person, company or financial institution with whom the undersigned has dealings.

Authorized Signature:                                                       Title:                                

Date:                              

TRADE REFERENCES: Company Name/Phone Number/Contact

1.                                                                                                                          

2.                                                                                                                          

3.                                                                                                                          

Office Use Only:

References Checked:                                             Credit: __________________

Approved:                                                                         

Limit: $                                                                  

Terms:                                               

Date: