New Customer Credit Application

Applicant's Information:

Business Name:

Street Address:

City:

Province:

Postal Code:

Business Phone Number:

Fax:

Website:

Email:

Annual Revenue:

Credit Requested:

Date Business Commenced:

Rent or Own?:

Name of Landlord (if applicable):

Landlord's Phone Number:

Name of Bank:

Bank Address:

Bank's Phone Number:

Bank Manager's Name:

Account #:

Client Since:

Trade References

Reference #1:

Name: Address: Phone: Fax:

Reference #2:

Name: Address: Phone: Fax:

Reference #3:

Name: Address: Phone: Fax:

Reference #4:

Name: Address: Phone: Fax:

Principals

Principal #1

Name: Home Address: Phone Number: Position:

Principal #2

Name: Home Address: Phone Number: Position:

Agreement

In consideration of credit being granted, I agree to pay in accordance with the terms and conditions of sale as set out by the seller. In the event of non-payment, I agree to reimburse the seller all reasonable costs, including legal fees, incurred by the seller, to collect the account.

I agree.