CREDIT APPLICATION FORM

CREDIT APPLICATION FORM
LOCATIONS: BURNABY, BC | FORT ST JOHN, BC WILLIAMS LAKE, BC
*FOR ADDITIONAL QUESTIONS PLEASE EMAIL ZOE@NORTHERNEP.CA
Credit Requested*
CUSTOMER INFORMATION
Company Legal Name*
Company Operating Name*
Business Address*
City*
Postal Code*
Delivery Address
(If same as business address leave empty)
City
Postal Code
Phone Number*
Website

Years in Business*
Number of Employees*
Owner/Director*
Title*
Office Number*
Cell Number*
AP Contact*
AP Email*
example@example.com
AP Phone Number*

BANK INFORMATION
Name of Bank*
Phone
Fax
Address*
Institution Number*
Transit Number*
Account Number*
Contact Person*
Phone*
Email*
example@example.com

TRADE REFERENCES
Company Name*
Contact*
Phone*
Email*
example@example.com
Company Name*
Contact*
Phone*
Email*
example@example.com
Company Name*
Contact*
Phone*
Email*
example@example.com

ADDITIONAL INFORMATION
Do you require PO's?

YesNo
Are you PST Exempt?

YesNo
If yes please provide your PST number below
Would you like credit with our other subsidiaries?

Grosso Precast - Williams LakeGrosso Precast - Fort St. JohnNVT Logistics - Fort St. JohnWilson Concrete & Gravel - Fort St. John
Please list the names of your authorized buyers*

TERMS & CONDITIONS
A) Terms of Sale are NET 30.

B) 2% interest per month will be charged on all accounts over 30 days.

C) I grant permission to the company to contact any references given, including banks, to release financial information for credit investigations.

D) I agree that the company legally retains ownership of the goods and does not consider the sale finalized until the full payment has been made.

I hereby accept to the terms and conditions listed above.
Authorized Signature*

Clear
Name*
Date*

MonthDayYear
Date
Should be Empty: