5700 Keaton Crescent Mississauga, Ontario Canada L5R 3H5 Telephone (905) 272-0727 X351 Toll free (800) 387-9496 Facsimile (905) 897-7470 www.arconas.com mspringle@arconas.com
Credit Application Company Name: Address: Address: Telephone:
(
)
Fax: (
)
Principal(s):
Title:
State (Prov)Tax #:
Fed Tax #:
Credit Amount: $
Tax ID #:
Please supply Name, Address, Telephone/Fax Numbers of Three (3) Current Suppliers: 1)
2)
3)
Tel #: (
)
Fax #: (
)
Tel #: (
)
Fax #: (
)
Tel #: (
)
Fax #: (
)
Bank:
Acct #:
Address:
Tel #: Fax #
Manager:
________________________________
Signature:
Terms: Arconas is hereby authorized to obtain trade and bank references as required. Our terms of payment require 1/3 with order, 1/3 on shipping, 1/3 net 30 days OAC. I, the undersigned officer, apply for credit under the above terms: Signature: ____________________________________ Title
: _______________________________