Applicaton For Credit Form printable pdf download

Applicaton For Credit Form

10406 -31A Avenue

Edmonton, AB T6J 3B4

Tel 780.905.1871

Fax 780.434.7958

APPLICATON FOR CREDIT

Company Name:_____________________________________________________

Address: ___________________________________________________________

City: ___________________________ Prov___________ Postal Code __________

Phone (___) ____________Fax (___)_____________

Type of Ownership: Corporation______ Partnership______ Individual_____

If Partnership or Individual, complete information on second page.

Officer Name: ________________________

Title: ________________________

Officer Name: ________________________

Title: ________________________

Years in Business: __________ Type of Business: __________________________

Are Purchase Orders required? Yes_____ No _____

Accounts Payable Contact: _______________ Email Address: ________________

BANK INFORMATION

Bank Name __________________________________ Phone (___)__________________

Address ______________________ City ____________ Prov ____ Postal Code_________

CREDIT REFERENCES: (please give complete addresses)

Name _______________________ Phone (___)_____________ Fax (___)_____________

Address ______________________ City ____________ Prov ____ Postal Code_________

Name _______________________ Phone (___)_____________ Fax (___)_____________

Address ______________________ City ____________ Prov ____ Postal Code_________

Name _______________________ Phone (___)_____________ Fax (___)_____________

Address ______________________ City ____________ Prov ____ Postal Code_________

Applicaton For Credit Form