Credit Application
[FrontPage Save Results Component]

To open a new account, please start by clicking the "New Account" button.
When the form refreshes, fill out the application in full and then click the "Submit" button.

Legal Company Name: 
Trade Name (if different from above): 
STREET ADDRESS
Address:
City:
Province/State:
Postal/Zip:
Country:
Phone:
Fax:
MAILING ADDRESS
Address:
City:
Province/State:
Postal/Zip:
Country:
FINANCIAL INFORMATION
A/P Contact
Bank Name:
Branch:
P.O's Required? Yes
COMPANY INFORMATION
Sole Ownership:        Partnership:        Corporation: 
Name of Principals
Name: Title:
Name: Title:
Name: Title:
Major Suppliers
Name: Phone:
Name: Phone:
Name: Phone:
AUTHORIZATION
Completed By:
Name: Title:
Date (MM-DD-YYYY):

Note: Terms of payment are 30 days from date of invoice.
1.5% interest per month (18% per annum) on past due accounts.