|
Please print the following Credit Application
and fax it to: |
|
Name of Business: |
|
| Type of Business: | |
| Address: | |
| City: | |
| Province: | |
| Postal Code: | |
| Telephone Number: | |
| Contact: | |
| Fax Number: | |
| Incorporation Date: | |
| Mailing Address: | |
| City: | |
| Province: | |
| Postal Code: | |
| Accounts Payable Contact: | |
Credit Information
|
|
| Bank Reference: | |
| Telephone: | |
| Bank Branch: | |
| Contact: | |
| Suppliers Reference including phone number & contact person: | |
| Supplier: | |
| Telephone: | |
| Contact: | |
| Supplier: | |
| Telephone: | |
| Contact: | |
| Supplier: | |
| Telephone: | |
| Contact: | |
| Credit Amount Requested: | |
| Date: | |
| Name of Authorized Person: | |
| Title: | |
