Credit application

* please complete all fields
PART 1 – IDENTIFICATION
Applicant Company :
Ship to Address:
Mail to Address :
City:
PROV:
POSTAL / Zip code :
Tel:
Website URL:
General Email Address :
GST # (for Canada only):
PST # (for Canada only):
FEDERAL TAX ID:
ASI #:
PPPC #:
PART 2 – CONTACT
Payables:
Ext.:
Email:
CFO/Controller:
Ext.:
Email:
PART 3 – FINANCIAL INSTITUTION
Account #:
Trans/Branch:
Tel.:
Ext:
Email
Contact:
PART 4 – TRADE REFERENCES
1. Company:
Account #:
Email:
Contact:
2. Company:
Account #:
Email:
Contact:
3. Company:
Account #:
Email:
Contact:
PART 5 – AGREEMENT
It is understood by submitting electronicaly, that Expressions will conduct credit inquires on behaf of the Applicant Company. We share credit history with suppliers when listed as a reference. Credit privileges are 2% 10 days, net 30 days.
Name:
Comments: