Usa Credit Application Form
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1
2USA CREDIT APPLICATION
Return completed form by email to or by fax at (604) 299-5464.
Standard processing time of three business days applies. Please complete all fields to speed processing.
NAME OF BUSINESS (BILLING ADDRESS)
SHIPPING ADDRESS
Name _________________________________________
Name _________________________________________
Address _______________________________________
Address _______________________________________
City __________________________________________
City __________________________________________
State ___________ Zip Code ____________________
State ___________ Zip Code ____________________
Phone ________________________________________
Phone ________________________________________
Fax __________________________________________
Email (main address) ____________________________
Website _______________________________________
COMPANY INFORMATION
o Corporation
o Proprietorship
o Partnership
IRS# (required for export) _________________________
How many years in business? _____________________
Date of incorporation ____________________________
Business premises are:
o Owned
o Leased
Landlord’s Name ______________________________________________________________________________________
Landlord’s Address ____________________________________________________________________________________
City __________________________________________
State ___________ Zip Code ____________________
Names and addresses of Proprietors and Principals:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Have you or other Principals of your business ever been or are currently in bankruptcy proceedings?
o Yes
o No
Have creditors filed any judgements against your company?
o Yes
o No
PAYABLES
Contact Person _________________________________
Title __________________________________________
Phone ________________________________________
Fax ___________________________________________
Email _________________________________________
I prefer invoices sent via:
o Email
o Fax
o Mail
Are purchase orders used?
o Yes
o No
If NO, please list names of persons authorized to submit orders:
____________________________________________________________________________________________________
Credit Limit Requested _______________________
WE ACCEPT YOUR TERMS OF SALE, NET 30 DAYS
Name _______________________________________
Signed ____________________________________
Non adherence to Geo. Bezdan Sales Ltd.'s terms of sale will result in your account being placed on C.O.D.
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• 1-800-663-6356
1
04/15
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Parent category: Business