credit application

Company Information

Business Name: *
Address: *
City: *
Province:
Postal Code: *
Phone:
Fax:
How Long in Business?
Registered Legal Name:
Related Companies:
Company Type: Proprietorship
Partnership
Limited Company

 

Bank Reference

Bank Name:
Address:
Phone:
Account #

 

Principal(s) Information

Name:
Home Phone:
Home Address:
   
Name:
Home Phone:
Home Address:
   
Name:
Home Phone:
Home Address:

 

Trade References (Previous ....or Related)

Supplier Name:
Location / City:
Phone:


Supplier Name:
Location / City:
Phone:

 

Supplier Name:
Location / City:
Phone:

 

Supplier Name:
Location / City:
Phone:

 

I/we hereby request to establish credit privileges with (Fujiya Japanese Foods) and agree to pay for all purchases in accordance with your net 15 day terms and further agree to pay a service charge on any amounts past due calulated at 2% per month (26.8% per annum).

 

I/we certify the above information to be correct. Further, (Fujiya Japanese Foods) is authorized to abtain credit reports or other information as deemed necessary, on both the company and the principals, to establish this account and for the ongoing maintenance and collection of this account or for any other business reason. This consent is given pursuant to Chapter 78, section 12, of the Credit reporting Act, R.S.B.C. 1979.

 

Name:
Position:
Email:
Date: