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Credit Form


CONFIDENTIAL CREDIT APPLICATION
Company name (trading): 
Legally registered name or number: 
Billing address: 
City:
Postal Code:
e-mail address:
Telephone:
Fax:
Credit amount requested:
Year established:
Type of business: Partnership or Proprietorship
Corporation
Subsidiary
Other 
Person to contact re: accounts payable:
Purchase order required: Yes      No
Sales tax numbers: GST number PST number
 Exempt
 Taxable

Bank References
Name of Bank
 Contact
Branch address
 City
Account number
 Telephone

Supplier References (names of 3 suppliers with whom you have established credit)
Company name
 Contact
How long
 Telephone
 		 Fax
Company name
 Contact
How long
 Telephone
 		 Fax
Company name
 Contact
How long
 Telephone
 		 Fax
 
Are you a member of a credit association?   Yes   No
If so, which one?
   

Our terms are net 30 days. 2% per month (24% per annum) interest charges will be added and payable on any outstanding balance over 30 days. All past due accounts will be forwarded to CREDITEL CANADA LIMITED who has the authority to proceed further on our behalf failing receipt of payment at our office. The applicant agrees to pay interest charges outlined above and any additional costs of collecting their account by a third party collector. The applicant hereby grants his/her constent for a Banker Business Report and/or investigation of credit information in connection with this application.

By submitting this form, I hereby make application for net 30 day open account privileges with Aditek Design and Printing on behalf of the named company on this application and agree to the above terms.



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