Address
Address
Telephone Number
Telephone Number
Fax Number
Fax Number
Bank Phone Number
Bank Phone Number
Bank Address
Bank Address
Bank Official
Bank Official
Trade References (Firms Currently Extending Credit).
Terms Net 30 days on approved credit.
All NSF Cheques are subject to a $40 handling charge.
Print Name
Print Name
Date
Date
By submitting this form, You are hereby requesting that an account be opened and credit be extended according to the terms outlined above. In addition you hereby authorize any credit inquiries that are considered necessary and that the information is true, accurate and complete.