Application for Trade Credit [TCAF-25]
Disclaimer
By entering your name below, you are effectively providing your signature, indicating that all further information entered is true and correct to the best of your knowledge.
Your Name
*
First Name
Last Name
I hereby sign this form, indicating that any information submitted is true and correct to the best of my knowledge.
*
Yes
Do you currently have credit with Mintech?
*
Yes
No
Upload your signed Terms of Trade (available on the 'Apply for Trade Credit' page
*
Browse Files
Drag and drop files here
Choose a file
Terms of Trade Credit document available for download on the 'Apply for Trade Credit' page on the Mintech website.
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of
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Company Information
Company Name
*
Company Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Email
*
example@example.com
Primary Contacts
*
Rows
Full Name
Phone Number
Direct Number
Email Address
Finance Manager
Finance Assistant/Officer
Purchasing Manager
Purchasing Assistant/Officer
Stores/Inventory Receival Manager
Company Type
*
Sole Proprietor
Limited Partnership
Limited Liability Company
Trust
Government Entity/Body
Other
Tax Class
*
GCT
Tax Withheld Entity
Tax Exempt
Business Sector
*
Please Select
Aggregates/Mining
Asphalting & Paving
Automotive & Garage
Aviation
Building & Construction
Chemicals
Distribution
Engineering
Farming & Agriculture
Financial Services
Food & Beverage Processing
Hospitality/Tourism
Irrigation
Janitorial & Maintenance
Manufacturing
Petroleum & Gas
Power/Energy
Restaurant
Security
Shipping/Logistics
Supermarket
Other
Company Registration Number
*
If the company is a government entity and the registration number is not applicable, please enter 00000 in this field.
Registration Date
*
-
Month
-
Day
Year
Date
Tax Registration Number
*
Postal Address
*
Street Address
Street Address Line 2
City
Parish
Postal / Zip Code
Separate Physical Address
*
Yes
No
Physical Address
Street Address
Street Address Line 2
City
Parish
Postal / Zip Code
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Staffing & Product Usage
Applicable Product Categories
*
Safety Footwear
Material Handling & Storage
Uniforms (Branded/Plain)
Plastic Pallets
General PPE
Total Staff Complement
*
1 - 25
26 - 50
51 - 100
101 - 250
251 - 500
501 - 1,000
1,000+
Total Staff Using Safety Footwear and PPE
*
1 - 25
26 - 50
51 - 100
101 - 250
251 - 500
501 - 1,000
1,000+
Total Staff Using Workwear/Corporate Apparel
*
1 - 25
26 - 50
51 - 100
101 - 250
251 - 500
501 - 1,000
1,000+
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Trade References & Payment Cycle
Standard Payment Cycle
*
Weekly
Monthly
Bi-Monthly
Ad-Hoc
Preferred Payment Method(s)
*
Bank Wire
Cheque
Credit/Debit Card
Trade References
*
Rows
Company Name
Credit Terms
Credit Value
Contact Name
Contact Title
Contact Phone
Reference 1
Net 7 Days
Net 15 Days
Net 21 Days
Net 30 Days
30+ Days
< $500,000
$500,000 - $1,000,000
$1,000,000 +
Reference 2
Net 7 Days
Net 15 Days
Net 21 Days
Net 30 Days
30+ Days
< $500,000
$500,000 - $1,000,000
$1,000,000 +
Reference 3
Net 7 Days
Net 15 Days
Net 21 Days
Net 30 Days
30+ Days
< $500,000
$500,000 - $1,000,000
$1,000,000 +
Submit
Should be Empty: