Customer Credit Application

Customer Credit Application

Northern Welding Supplies Ltd.
Email
example@example.com
Company Name*
Date*

MonthDayYear
Date
Representative Name*
Phone*
In Business Since
Company Email*
example@example.com
Accounts Payable Email*
example@example.com
Do you require a PO?*

YesNo
Type of Company
Corporation, sole proprietor, partnership
Billing Address*

Street Address

CityState / Province

Postal / Zip Code
Is your shipping address the same as billing?*

YesNo
Shipping Address*

Street Address

CityState / Province

Postal / Zip Code
Bank Reference
Name of Bank*
Phone*
Bank Representative Name*
Bank Address*

Street Address

CityState / Province

Postal / Zip Code
Trade Reference (1st)
Company Name*
Contact Name*
Phone Number*
Email*
example@example.com
Trade Reference (2nd)
Company Name*
Contact Name*
Phone Number*
Email*
example@example.com
Trade Reference (3rd)
Company Name*
Contact Name*
Phone Number*
Email*
example@example.com
Your Name*
Signature*

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1. CORRECTNESS OF INFORMATION.

By submitting this form, you affirm that the information provided herein is true and correct. Any misrepresentation or incorrect information shall be cause for rejection.

The Borrower shall make payments under this agreement by credit card, cheque, EFT, or any other method agreed upon by the parties. Additionally, all payments shall be made within 30(thirty) days of the invoice. A 2% interest rate per month will be applied on past-due balances.

Any information acquired through this agreement shall be recognized as Confidential Information. The parties shall keep confidential information confidential and exercise the same degree of care required by law.

This agreement and any disputes arising out of this agreement shall be dealt with under Alberta legislation.
Please verify that you are human*
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Customer Credit Application

Bank Reference

Trade Reference (1st)

Trade Reference (2nd)

Trade Reference (3rd)