Credit Application Form

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Company Name*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

HST Number

D-U-N-S Number

Website

Email*

Credit Limit Requested*

Principals and Officers of The Company

Proponent 1 Name*

First Last

Email*

Proponent 2 Name

First Last

Persons Authorized To Charge

Person 1*

Person 2

Bank Reference

Bank*

Account Number*

Contact*

Phone Number*

Trade References

(Three References Required)

Reference 1 Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

Phone Number*

Reference 2 Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

Phone Number*

Reference 3 Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

Phone Number*

Our Terms of Business

All invoices are NET 30, or past due thereafter. All accounts past due will be subject to a finance charge of 2% per month. Applicant accepts the responsbility, ability, and willingness to pay our invoices in accordance with the above terms. Should the above terms not be met as agreed upon, the applicant agrees to pay reasonable attorneys fees plus interest.