Loading... noPaging < Prev Next > Credit Application We accept all forms of payment Please fill in all required fields. Credit application Trade / Legal Name Trade / Legal Name Address Address City City Province Province Postal Code Postal Code Phone Phone Fax Fax Type of Business Type of Business No. of Years in Business No. of Years in Business A/P Contact Person A/P Contact Person Email Email Check one: Check one: Sole Proprietor Partnership Corporation Limited Company Principals President or Owner President or Owner Treasurer or Partner Treasurer or Partner President or Owner’s home phone number President or Owner’s home phone number President or Owner’s home address President or Owner’s home address Phone Phone City City Province Province Postal Code Postal Code Bank Bank Branch Branch Bank Phone Number Bank Phone Number Bank Address Bank Address Business Credit References Company Name Company Name Address Address Email Email Phone Phone Company Name Company Name Address Address Email Email Phone Phone Company Name Company Name Address Address Email Email Phone Phone Estimated Annual Purchase Amount Estimated Annual Purchase Amount Credit Limit Requested Credit Limit Requested Are monthly statements required? Are monthly statements required? Yes No Are purchase order numbers required? Are purchase order numbers required? Yes No My signature below (a) certifies that the above information is correct; (b) indicates permission to obtain credit information from my bank and business credit references; (c) attests financial responsibility and willingness to pay invoices in accordance with terms; (d) gives consent to the disclosure of any information concerning the undersigned to any credit reporting agency, person, or firm with whom the undersigned has or may have financial relations. Authorized Signature Authorized Signature Title Title Date Date Choose the printer: Choose the thumbs down: Add Widget Add Section
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