Credit Application Form

Trade Name (in full):

Physical Address of Location:

Billing Address (if different):

Is Applicant An Incorporated Company?

If "Yes", Corporate Name:

or Incorporation Number:

Province of Incorporation:

Date of Incorporation:

Name And Position of Principals (1):

Name And Position of Principals (2):

Accounts Payable Contact:

Phone:

Fax:

*Email:

Nature of Business:

GST Number:

Year Commenced Business:

Bank Name:

Bank Address:

Account Number:

I/We apply to you for credit for the supply of services and materials. I/We jointly and severally indemnify you, and see you paid for your account with respect to any order or hereafter made by any of us on our behalf. I/We further agree to pay your account within your terms of net 30 days. In the event the account is delinquent and satisfactory arrangements have not been made for payment, I/We further agree to pay all Solicitor/Client fees and Disbursements incurred by you for taking any collection action. I/We consent to your obtaining and reporting our credit information.

Print name of authorized person completing form

Date:

Title:



Print name of authorized person completing form

Date:

Title:



Total Amount of Credit Required:

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