New Customer Credit Application Form

Any issues filling out the form? Please get in touch with us at contact@citypallets.ca

Fields marked with a * are mandatory.

SECTION A: COMPANY INFORMATION

Date

In Business Since

Type of Business

Corporation, Partnership, Proprietorship or Other (please indicate)

Legal Name*

Trade Name

Business Number

If Division/Subsidiary, Name of Parent Company

Authorized Contact Name*

Authorized Contact Title

Authorized Contact Telephone Number*

Authorized Contact Email*

Company Website

Head Office Phone Number

Head Office Address

SECTION B: DELIVERY INFORMATION

Delivery Address*

Purchasing Agent Telephone Number*

Purchasing Agent Name*

Purchasing Agent Email*

Shipping/Receiving Hours*

Additional Comments

Do you have a dock level door?*
Do you have a forklift?*
Do you have a licensed forklift driver?*

SECTION C: ACCOUNTS PAYABLE INFORMATION

Billing Address (if different from above)

Accounts Payable Contact Name

Accounts Payable Email

Accounts Payable Telephone Number

Invoice Email

Accounts Payable Manager Name

Accounts Payable Manager Email

Accounts Payable Manager Telephone

SECTION D: TRADE REFERENCES

Please provide current trade references from companies you have engaged with or purchased from within the last year. The following information is required to establish the payment term. If not provided, all sales are due upon receipt.

REFERENCE 1

Company Name*

Contact Name

Company Address

Company Telephone

Company Fax

Company Email*

REFERENCE 2

Company Name*

Contact Name

Company Address

Company Telephone

Company Fax

Company Email*

REFERENCE 3

Company Name

Contact Name*

Company Address

Company Telephone

Company Fax

Company Email*

The undersigned confirms that the above information is true, correct and complete. We authorize the company to contact the listed trade references and disclose the necessary credit history for this application, including any renewals or extensions. This information may be obtained from credit agencies or relevant financial entities. All gathered data is strictly for financial evaluation.

Trade references are typically verified within 2-5 business days.

Authorized Title

Signature (please use your mouse or finger to draw your signature in the box below)

New Customer Credit Application Form

SECTION A: COMPANY INFORMATION

SECTION B: DELIVERY INFORMATION

SECTION C: ACCOUNTS PAYABLE INFORMATION

SECTION D: TRADE REFERENCES

REFERENCE 1

REFERENCE 2

REFERENCE 3

Company

Products

City Pallets Inc.