TERMS
NET 21 DAYS

Please note that you can complete this form and submit online or you can print and fax it to us at (416)754-1161, or toll free (888)823-5770.

Company:   
Mailing Address:
City:
Province/State: (e.g. ON)
Postal/Zip Code:
Accounts Payable Contact:
Telephone: () -      Ext.
Fax: () -    
E-mail:
Years In Business:

 

Commercial Bank:
Contact:
Telephone: () -      Ext.
Fax: () - 
Account #:

 

Reference #1
Company:
Contact:
Telephone: () -      Ext.
Fax: () - 
Reference #2
Company:
Contact:
Telephone: () -      Ext.
Fax: () - 
Reference #3
Company:
Contact:
Telephone: () -      Ext.
Fax: () - 

 

Submitted By:
Title:
Date Submitted:

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