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Credit Application

Company Details:

Company Name:
Street Address:
City:		Postal Code:
Business Phone:		Fax:
President/Owner:		Type of Business:

Credit Information:

Bank:		Address:
Length in Business:		# of Employees:
I.R.S. # (US customers):		P.S.T. # (Cdn. customers):

Canadian Trade References:

	Name:	Address:	Phone #:	Fax #:
1)
2)
3)

US Trade References:

	Name:	Address:	Phone #:	Fax #:
1)
2)
3)