Application for Credit

Full Name of Business: Billing Address: City: Postal Code: Shipping Address: City: Postal Code: Phone Number: Fax Number: GST Number: PST Number: Bank Information Name: Phone Number: Address: Contact Name: Account Number: Business Information Business Type: Proprietorship Partnership Limited Company When was the business established? Estimated Credit Requirements: Principal(s) Name(s) and Address(es) Name: Address: City: Postal Code: Home Phone: Name: Address: City: Postal Code: Home Phone: Credit References 1. Name: 1. Address: 1. City: 1. Postal Code: 1. Home Phone: 2. Name: 2. Address: 2. City: 2. Postal Code: 2. Home Phone: 3. Name: 3. Address: 3. City: 3. Postal Code: 3. Home Phone: 4. Name: 4. Address: 4. City: 4. Postal Code: 4. Home Phone: Name and amount of any supplier’s accounts which are overdue: 1. 2. 3. I, the undersigned do hereby certify that the above statement and information is correct, and that I am an authorized officer of the above company. To make this application, I also do hereby agree to guarantee personally the payment on any or all amounts which the above company may default on. I also do hereby agree to all conditions of sale which may be stated on packing slips or individual order invoices and are outlined (below) on this application. The applicant does hereby agree to pay all accounts within 30 days, unless otherwise stated, and also agree that in the event of delinquent accounts, to forfeit any discounts, and pay 2% per month interest on each 30 days the account is overdue. Dated at: Applicant: Date: Witness: