ACTION Credit Application

Credit Terms

You call on us to deliver very quickly and we always give it our best. In return we ask that you pay us very quickly as well.

Name of Business & Address

	Legal Name of Company *		Phone *

	Trade Name		Fax

	Email Address *		GST Number *

	Street *		City *

	Province *		Postal Code *

	Established Date		Nature of Business

Billing Address (if different)

	Street		City

	Province		Postal Code

Form of Business

Proprietorship

Partnership

Corporation

Other

Describe if Other

Full Name and Address of Owner and Partner (if other than corporation)

	Name		Address

	Name		Address

Other Company Information

	Name of Parent Company & Affilation (if any)		Nature of Business

	Date Business Started		Number of Employees

Premises (Check Appropirate Box)

Owned

Rented

Landlord Information (if Rented)

	Name		Phone

	Address

Bank References

Bank Name and Branch Number *

Phone *

Address *

Account Number*

Bank Contact

Title

Chequing

Saving

Chequing & Saving

Trade References (minimum of 3 are required)

Trade Reference Name *	Address *	Phone *

I hereby represent that I am authorized to submit the application on behalf of the customer named above, and that the information provided for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize Action to investigate the references listed pertaining to my my/our credit and financial responsibility. It is agreed and understood that all the necessary collection and legal and interest (at 26.82% per annum maximum) may be charged to my company in the event of default or failure to pay for services rendered. I/we further represent that the customer applying for the credit has the financial ability and willingness to pay for all the invoices within the established terms.

The undersigned (A) certify all the information above to be true and complete, (B) authorize and consent to the receipt and provision of account and credit information from and to the Credit Grantors, Credit Bureaux, and Supplies of Service.

Account#

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Password :

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