CREDIT APP

Humber Group Credit Application
Business Contact Information
Company Name*
Contact*
Phone*
Fax
Email*
example@example.com
Address*
Province*
Postal Code*
Billing Information
Billing Name*
Address*
City*
Province*
Postal Code*
Contact*
Phone*
Fax
Email*
example@example.com
Business & Credit Information
Number of Years in Business*
Estimated Monthly / Annual Requirement: Credit Limit Requested / Approved:
Estimated Monthly / Annual Requirement*
Credit Limit Requested / Approved*
HST Number *
Bank Information
Name of Bank or Institution*
Account Number*
Vendor Credit References
Vendor Contact #1*
Phone*
Fax*
Email*
example@example.com
Address*
Province*
Postal Code*
Vendor Contact # 2
Phone
Email
example@example.com
Phone
Address
Fax
City
Prov.
Postal Code
Vendor Contact # 3
Phone
Email
example@example.com
Phone
Address
Fax
City
Prov.
Postal Code
Name
Contact
Email
example@example.com
Phone
Address
Fax
Prov.
Postal Code
Applicants Name *
Postal Code: Prov. City: I (we) the undersigned have the authority to sign for and bind the corporation completing this credit application. about I (we) consent to Humber Aggregates & Soil Mixtures Ltd. (The Humber Group) obtaining information the corporation and applicant personally from third parties at any time during the application process and afterwards. Further, if an account is opened, I (we) consent to the disclosure of credit information to reporting agencies as well as suppliers/vendors of Humber Aggregates & Soil Mixtures Ltd. (The Humber Group Furthermore I (we) represent and warrant that the information in this application is correct in all aspects.
Applicants Signature*

Clear
Position*
Date*

MonthDayYear
Date
Humber Aggregates & Soil Mixtures Ltd. 47 Ingram Dr. Toronto ON M6M 2L7 P: 416-931-3811 E: sales@thehumbergroup.ca
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Business Contact Information

Billing Information

Business & Credit Information

Bank Information

Vendor Credit References