Credit Application Form

Business Information

Description of Business

Date

Legal Name:

Business Structure:

Trade Name:

c    Sole Proprietorship

c    Partnership

c    Corporation

c    Division/Subsidiary

Parent Company                                                                       

Billing Address:

City/Province:

Postal Code:

Telephone:

Type of Business:                         No. of Employees:

Fax:

Years in Business:

Shipping Address (if different):

GST No/ Federal ID #.:

City/Province:

Postal Code:

PST No./ State ID No. (Resale No.):

PO Required?

     c  Yes    c  No

If Tax Exempt, please enclose Tax Exemption certificate

Estimated Annual Sales

Net Worth

DNB  #