New Account Application

CUSTOMER INFORMATION

Company Name:

Date:

Street Address:

Unit/Suite/Apt. Number:

City:

Province:

Postal Code:

Phone Number:

Fax Number:

Authorized Person:

Years In Business:

Email Address:

Ship To Address:

Same As Above

Street Address:

Unit/Suite/Apt. Number:

City:

Province:

Postal Code:

Phone Number:

Fax Number:

Email Address:

Choose your preferred credit approval method:

Provide Bank and Trade References
Place a credit card on file

Title Print Name Signature

I, the applicant (authorized officer of the company), Agree that the information provided above is factual and, Upon credit approval, Will adhere to the terms NET30 set forth by the company. Any Accounts over 30 Days past due will have all orders held, A 2.5% monthly interest charge applies for all past due accounts.

Title

Print Name

Signature

New Account Application

CUSTOMER INFORMATION

Ship To Address:

Choose your preferred credit approval method:

Trade References

#1 Company:

#2 Company:

#3 Company:

Bank Reference

Credit Card Use Authorization Form

Credit Card Options:

Title Print Name Signature

Category