Customer Credit Application

Business Information

Business Name *

Phone *

Contact Name *

Fax

Email *

Address *

City *

Prov *

Postal Code *

PST Exempt #

GST #

Credit Card on File

Only enter your credit card number below if you want us to charge your card at every month end for the outstanding balance.

Credit Card #

Exp (MM/YY)

Sec. Code

Which date of the month would you like us to take the payment?

References

Reference 1 *

Name *

Phone *

Address

Fax

Reference 2

Name

Phone

Address

Fax

Reference 3

Name

Phone

Address

Fax

Bank Name and Address

Account Details

Is Purchase Order Required? *

Estimated Monthly Credit Amount *

Accounts Payable Contact Name

Accounts Payable Email

Accounts Payable Phone

Authorized Individuals (can charge on account)

Name 1

Contact Info 1

* If there are any changes in the authorized individuals please contact us immediately and we will update your account.

Terms & Signature

TERMS: All accounts are NET 30 DAYS. Interest @ 2% per month will be charged on all invoices which are more than 30 days in arrears. Failure to follow these terms would be grounds for termination of credit. All past due accounts will be charged to the credit card on file.

Date *

Signature (type your full name) *

Récupération du mot de passe

Création de compte

Customer Credit Application

Credit Applications

Business Information

Credit Card on File