Full Name of Company
Trading As
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Name Name First Last
Phone Phone - ### - ### ####
Fax Fax - ### - ### ####
Email
Cell Phone Cell Phone - ### - ### ####
PDF Invoicing

PDF Invoicing Yes
PDF Statements

PDF Statements Yes
Trade Reference #1

(Include Company Name, Phone, Fax, Email, and # of years doing business)
Trade Reference #2

(Include Company Name, Phone, Fax, Email, and # of years doing business)
Trade Reference #3

(Include Company Name, Phone, Fax, Email, and # of years doing business)
Trade Reference #4

(Include Company Name, Phone, Fax, Email, and # of years doing business)
Company Information
Type of Business:
Years of business under present name
Company Officer (2):

Name & Title
Company Officer (1):

Name & Title
Office

Office Owned Leased Rented Other
Estimated Credit Required (Monthly)
GST #
PST #
Accounts Payable Contact
Purchasing Agent
Do you have additional owners not listed on the application?

Do you have additional owners not listed on the application? Yes
Is there anyone not listed on the business application agreement that has authority to make
financial decisions on behalf of your business?

Is there anyone not listed on the business application agreement that has authority to make
financial decisions on behalf of your business? Yes

Company Information