Credit Application
Company Information
Company Name:
Contact Email:
Contact Phone:
Contact Fax:
Line of Business or Profession:
# of Employees:
Years Established:
GST #:
PST #:
Billing Address
Address:
City:
State / Province:
Zip / Postal Code:
Country:
Company Ownership
Type:	Individual Partnership Corporation
Principals (Name, Title):
Credit Reference
#1- Company Name:
Address:
City, State, Zip / City, Province, Postal Code:
Phone:
Fax:
#2- Company Name:
Address:
City, State, Zip / City, Province, Postal Code:
Phone:
Fax:
#3- Company Name:
Address:
City, State, Zip / City, Province, Postal Code:
Phone:
Fax:
#4- Company Name
Address:
City, State, Zip / City, Province, Postal Code:
Phone:
Fax:
Bank Reference
Bank Name:
Address:
City, State, Zip / City, Province, Postal Code:
Phone:
Fax: