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Credit Application
Legal Name
Business Information
Business Structure
Proprietorship
Partnership
Corporation
H.S.T Number
Number of Employees
Amount of Credit Requested
Operating Name
Date of Incorporation
Year
/
Month
/
Day
Nature of Business
Years in Business
Business Information
Authorized Person for Purchasing
Telephone
Fax
Email Address
*
Billing Address
Please include city, province/state, and postal code along with your address.
Accounts Payable Contact Name
Accounts Payable Phone Number
Accounts Payable Email Address
Names of Owners/Officers of the Company
Name
Position
Phone
Email Address
Bank References
Bank Name
Branch
Bank Phone Number
Bank Fax Number
Branch Address
Please include city, province/state, and postal code along with the address.
Contact Name
Account Number
Email Address
Credit References
Reference 1
Company Name
Contact Name
Email
Phone
Fax
Reference 2
Company
Name
Email
Phone
Fax
Reference 3
Company
Name
Email
Phone
Fax
+ Add New Reference...
I/We hereby authorize Intellimeter Canada Inc. and/or their agents, to obtain credit information from our bank & trade references listed above. In consideration of any extension of credit, purchaser agrees to the terms hereof and to the conditions of sale set forth on each invoice.
*
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