Credit Application - Northern Plastics Ltd. - Specialty Industrial Plastic Products

Company Information

Your Name *
Purchasing Contact
Accounts Payable Contact

Credit Limit Desired *

Company Name *
Address Line #1 *
Address Line #2
Shipping Address *
City *
Province/State *
Country *
Postal/Zip/Area Code (or N/A) *

Phone * / Ext.	/
Fax *
Email Address
Website URL

Will Purchases be BC PST Exempt
PST Number

GST/Federal Tax ID (IRS) No. *

Date Company Established *	/ /
Type of Company *

Company Industry *

Principals of Company

Name / Title #1 *
Name / Title #2
Name / Title #3

Bank Information

Bank Name *
Bank Phone *
Bank Contact Person *
Branch Address Line #1 *
Branch Address Line #2
Branch City *
Branch Province/State *
Branch Country *
Branch Postal/Zip/Area Code (or N/A) *

Credit References

Note: Please do not use company/personal references with which your company has any affiliation, or have a "non-arms length" relationship with. Fax numbers are required for references. Thank You.

Equifax / CrediTel Number (if known)


Other Information

How did you hear about us?

Please Read and Acknowledge

The above information is for the purpose of obtaining credit and is warranted to be true. I am aware of Northern Plastics Ltd. credit terms of Net 30 days, and agree to pay all invoices within this time, or as otherwise expressly agreed. I am a legal, bonafide representative of the business applying for credit, and am fully authorized to enter into this agreement on their behalf. I hereby authorize the person or firm to whom this application is submitted to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirements. This information is provided in confidence to Northern Plastics Ltd. for the purpose of granting the above request for credit.

Today's Date	Monday, January 21, 2019
Your Name *
Your Title *

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