Business Credit Application Form

Business Credit Application

Personal Information
Date

Month Day Year Date Picker Icon
Name of owners or partners: *

First Name Last Name
How long have you lived in the community?
Name of owners or partners:

First Name Last Name
Name of owners or partners:

First Name Last Name
E-mail of Applicant *
Business Phone

Area Code Phone Number
Mobile Phone

Area Code Phone Number
Fax Number

Area Code Phone Number

Applicant Personal Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

When was business established:
What type of business is it?
Have you ever filed for bankruptcy either personal or as a principal in a business?

Yes No

Business Credit Application

Business Details
Business structure *

Partnership Single Owner Corporation
Employment Identification Number

Business Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Note: If Billing Address is not the same as above, please indicate below.

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Business Credit Application

Financial Information
Does the borrower have an up to date assets and liabilities statement? *

Yes No
Has your business been financed or given credit before? *

Yes No
Lender Name
Financing was for
List the name, address and telephone number of three or your major suppliers:
Name of your Bank:

Bank Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

What will be your credit requirements? $
# orders per week:
CREDIT TERMS: 1. __________ Day.
1. Any price discrepancies or returns must be reported on delivery to the driver, or call the office the same day (905.648.1324).
2. Credits will not be issued after 24 hours.
3. An NSF cheque is an automatic CASH DELIVERY thereafter.
4. Interest at 1.5% per month will be charged on overdue accounts.

Business Credit Application

Submit my Application
The information provided in this application shall not be shared to anyone else and is kept confidential
I agree that the information herein are true and correct *

Yes
Name

First Name Last Name
Title:
Date

Month Day Year Date Picker Icon
Signature
FOR OFFICE USE ONLY

Owner: Credit Manager: Date:

Credit Limit: Sales Manager: Date:
Should be Empty: