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Home Application For Open Account Credit

Application For Open Account Credit

CREDIT APPLICATION FOR OPEN ACCOUNT STATUS
In order to be able to order from lakesidefasteners.ca using a Company Purchase Order in lieu of cash, credit or other prepayment options, you need to be approved. Please complete the information below and submit by email or fax to:

Lakeside Fasteners, Ltd
Fax: 1-604-762-4418
email: sales @lakesidefasteners.ca

You can also download and print a copy of our CREDIT APP HERE.

COMPANY INFORMATION
Full Name of Business:  _______________________________________________________
Address:  ___________________________________________    Phone: _________________
City:  ____________________________ Postal Code: ________    Fax: ___________________
Do You Require:  o Purchase Order #   o Statement    May we send Invoices by o email    o Fax

Principles:  ______________________________     ______________________________
______________________________    ______________________________
Date Of Incorporation:  ____________________________ HST# ____________________

PURCHASING CONTACT                    ACCOUNTS PAYBLE CONTACT
Name: ____________________________    Name:  ____________________________
email:  ____________________________    email:  ____________________________
Website: _________________________________________________________________

BANKING INFORMATION
Name of Bank _______________________________________    Contact: ________________
Branch/Address _____________________________________    Phone: _________________

CHARGE ACCOUNTS & TRADE REFERENCES
Name _________________________________________ Phone: ______________ Fax: _______________
Address _______________________________________________________________________________
Name _________________________________________ Phone: ______________ Fax: _______________
Address _______________________________________________________________________________
Name _________________________________________ Phone: ______________ Fax: _______________
Address _______________________________________________________________________________
Please Note: The applicant is fully aware and understands that:
a) Our present terms are “Net 30 Days”
b) PAST DUE accounts are subject to an interest charge of 2% per month and cancellation of credit without notice and subject to third-party collection action after 65 days.
c) All charges must be paid before any claims can be processed.
d) Should any of the above be abused it may result in credit suspension or cancellation.

Consent
I hereby authorize the person or firm to whom this application is submitted to obtain such credit reports or other information deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirement. This consent is given pursuant to section 12 of the Personal Credit Reporting Act R.S.B.C. 1979.

Signed: __________________________________    Print Name: ________________________________
Position: _________________________________    Date:            ________________________________