Any issues filling out the form? Please get in touch with us at contact@citypallets.ca 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? YesNo Do you have a forklift? YesNo Do you have a licensed forklift driver? YesNo 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 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 We declare that the above information is true, correct and complete. We authorize the company to contact the above trade references. We authorize all trade references to disclose to the company any information concerning the credit history of our company. Authorized Title Signature (please use your mouse or finger to draw your signature in the box below) Clear
