Firm Name: ? Contact:
|
Address:
|
City: ? Prov/State:
|
Zip/Postal Code: ? Phone Number:
|
| Fax #: ? Email Address: |
Officers of Company:
President:
Secretary: |
Type of Firm:
Proprietorship: ? Partnership: ? Corporation: |
| Bank Information |
| Name of Bank: ? Phone Number: |
| Address: ? Account No: |
| Account Mgr: ? Amt. of Credit Requested:
|
| Tax No.: ? GST No.: |
| Years in Operation: ? How Often Will You Use Our Service/Month: |
| Closest Living Relative: ? Phone No.: |
| Trade References |
1. ? Phone No.:
2. ? Phone No.:
3. ? Phone No.:
|
| I/We understand the following and will abide by your company regulations:
1. If granted credit, I/we agree to pay all invoices within 30 days of invoice date.
2. It is agreed that I/we will pay 2% per month, which is 24% yearly, for all past due balances.
3. It is agreed that my/our account will become C.O.D. if I/we fail to pay invoices within the above stated terms.
4. My/our financial condition is satisfactory and I/we can meet all financial obligations.
5. There are no lawsuits or judgemets against me/us at this present time. If I/we default on payment of any outstanding valid invoices, I/we agree to pay legal and/or collection expenses.
In consideration of you extending credit to the undersigned, I/we jointly and severally agree to pay our account according to your usual terms of sale.
|
SIGNED THIS ____________ DAY OF ______________________ , 20____
AUTHORIZED SIGNATURE(s): _______________________________________________________
Second Signature: ________________________________________________________
(If applicable)
If you have put information in the form (above) that you wish to change,
simply highlight it and hit delete, and you will be able to re-write it.
You are now ready to submit your request.
Do so by clicking the "Submit Request" Button.
You may "submit" this form (as above) via the Internet for a preliminary credit check, however ultimately we will require a properly signed application. In this respect, and for confidentiality, you may wish to complete this form, then print it out on your printer and fax it to us at: (306) 651 - 5464.
|
| FOR WESTCAN LOGISTICS OFFICE USE ONLY:
Credit is hereby granted in the amount of: _______________
Date: __________________________________, 20_____
Signature: ___________________________________________________ |
? 
?
?
?
? 