CREDIT APPLICATION FORM |
Please Print, Complete, Sign and Fax to: Toll Free: 1-866-868-9171 / (905) 851-5609 |
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| Contact Information | Billing Information | ||||
| Contact Name | AP Contact Name | ||||
| Company Name | Company Name | ||||
| Address | Address | ||||
| Phone | Phone | ||||
| Fax | Fax | ||||
| General Company Information | |||||
| PST exempt # | Years in business | Years | |||
| Legal Structure | At present location | Years | |||
| Type of business | At previous location | Years | |||
Bank references |
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| Bank Name #1 | Bank Acct# / Type | ||||
| Bank Address | Bank City/Prov/Zip | ||||
| Bank Contact | Bank Phone | ||||
| Bank Name #2 | Bank Acct# / Type | ||||
| Bank Address | Bank City/Prov/Zip | ||||
| Bank Contact | Bank Phone | ||||
Trade References |
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| Company | Contact | Phone |
Fax | ||
| Signature & Authorization | |||||
| All accounts are COD until a credit application has been completed, reviewed and approved. If any indebt-ness, incurred pursuant to this request for credit, is not paid in full when due, the undersigned agrees to pay all costs for collection including court costs and a reasonable attorneys fee. Any balance so remaining unpaid shall bear interest at the lesser rate of 1.5% per month or the maximum rate permitted by applicable law, until paid in full. Singing this agreement indicates your acceptance of the terms and conditions as stated. In addition you authorize Buyer's Gallery Blinds Corp. to make any and all inquiries necessary to process this Credit Application. | |||||
| Name of
Authorized Representative:
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Date:
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| Agreed
and Accepted, Signed:
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Title:
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