Credit Form

Customer Data Sheet & Credit Application

Download Form

GENERAL INFORMATION:

FIRM OR BUSINESS NAME *

DOING BUSINESS AS (DBA) *

STREET ADDRESS *

BILLING ADDRESS *

CITY *

PROV *

POSTAL CODE *

TELEPHONE *

FAX *

Please list all offices and/or affiliate addresses below:

NAME *

TITLE *

NAME *

TITLE *

NAME *

TITLE *

E-MAIL ADDRESS *

ACCOUNTS PAYABLE/RECEIVABLE CONTACT *

YEARS IN BUSINESS *

HST NUMBER *

CREDIT CARD TYPE *

Sole Proprietorship
Corporation
Partnership

TYPE OF WORK *

Proprietor, Partners, Officers, if incorporated:

NAME *

HOME ADDRESS *

CITY *

PROV *

POSTAL CODE *

TELEPHONE *

NAME *

HOME ADDRESS *

CITY *

PROV *

POSTAL CODE *

YEAR BUSINESS ESTABLISHED: *

AT PRESENT LOCATION SINCE? *

List employee(s) names and titles that can sign contracts and/or authorize purchase orders/work orders on behalf
of your company:

1. *

2. *

3. *

4. *

ARE YOU ACCREDITED BY THE BETTER BUSINESS BUREAU? *

CREDIT REFERENCES: (Please provide three)

1. COMPANY NAME *

MAILING ADDRESS *

TELEPHONE NUMBER *

FAX NUMBER *

CONTACT PERSON *

TITLE *

E-MAIL ADDRESS *

HOW LONG HAVE YOU BEEN DOING BUSINESS WITH THIS COMPANY? *

2. COMPANY NAME *

MAILING ADDRESS *

TELEPHONE NUMBER *

FAX NUMBER *

CONTACT PERSON *

TITLE *

E-MAIL ADDRESS *

HOW LONG HAVE YOU BEEN DOING BUSINESS WITH THIS COMPANY? *

3. COMPANY NAME *

MAILING ADDRESS *

TELEPHONE NUMBER *

FAX NUMBER *

CONTACT PERSON *

TITLE *

E-MAIL ADDRESS *

HOW LONG HAVE YOU BEEN DOING BUSINESS WITH THIS COMPANY? *

AUTHORIZATION FOR RELEASE OF INFORMATION:

I hereby warrant that the above information is true and correct and is furnished for the purpose of establishing a
customer/vendor relationship with Ontario Rebars Inc. I hereby agree that Ontario Rebars Inc may investigate my
record and that, if approved, Ontario Rebars Inc may deliver this authorization to secure the information they need
to establish a business relationship.

NAME *

TITLE *

DATE *

Credit Form

Customer Data Sheet & Credit Application

GENERAL INFORMATION:

CREDIT REFERENCES: (Please provide three)

AUTHORIZATION FOR RELEASE OF INFORMATION:

Contact Info

Ontario Rebars Inc