Apply for credit

2275, 43rd Avenue Lachine, Quebec H8T 2K1 Canada
Tel: 514-631-0234 / 888-831-0234 Fax: 514-631-5682
www.ctcrubber.com

CREDIT APPLICATION FOR A BUSINESS ACCOUNT

BUSINESS CONTACT INFORMATION

Name & Title:

Company name:

Federal Tax ID Number:

Phone:

Fax:

E-mail:

Registered company address:

City:

Prov./State:

Postal/Zip Code:

Date business commenced:

Sole proprietorship

Partnership

Corporation

Other:

BUSINESS AND CREDIT INFORMATION

Primary business address:

City:

Prov./State:

Postal/Zip Code:

How long at current address?

Telephone:

Fax:

E-mail:

Bank name:

Bank address:

Phone:

City:

Prov./State:

Postal/Zip Code:

Type of account

Account number:

Savings:

Checking:

Other:

BUSINESS/TRADE REFERENCES

Company name:

Address:

City:

Prov./State:

Postal/Zip Code:

Phone:

Fax:

E-mail:

Type of account:

Company name:

Address:

City:

Prov./Stave:

Postal/Zip Code:

Phone:

Fax:

E-mail:

Type of account:

Company name:

Address:

City:

Prov./State:

Postal/Zip Code:

Phone:

Fax:

E-mail:

Type of account:

AGREEMENT

1. All invoices are to be paid 30 days from the date of the invoice.

2. Claims arising from invoices must be made within seven working days.

3. By submitting this application, you authorize Contact Rubber Inc., to make inquiries into the banking and business/trade references that you have supplied.

SIGNATURES


Title:		Title:
Date:		Date: