Credit Appplication

CREDIT APPLICATION

Business Information

Business Name/Trade Name:

Mailing Address:

City:

Prov:

Postal Code:

Physical Address:

City:

Prov:

Postal Code:

Phone No.:

Fax No.:

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Start Section Other Branch Locations (permitted to bill to this account):

Other Branch Locations (permitted to bill to this account):

Other Branch Locations

Branch 1

Contact Information of Partners/Directors responsible for this account:

Branch Locations Repeater

Name:

Phone No.:

Email:

Address:

City:

Prov:

Postal Code:

Phone No.:

Fax No.:

Email:

Shipping/Receiving Contact Name:

Email:

Invoicing & Contact Information:

Accounts Payable Contact Name:

Phone No.:

Email ( for invoice submission ):

Invoicing Requirements?:

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Shipping/Receiving Contact Name:

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Email:

Can you meet our 30-Day Terms?

Yes

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Can you meet our 30-Day Term? Yes

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If “No” state reason why:

Business Industry:

Years in business:

GST#

Credit Limit Requested:

This business is a:

Proprietorship

Partnership

Corporation

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Start Section Business References

Business References

Business References Repeater

Name:(Required)

Phone No.:(Required)

Email:(Required)

The undersigned hereby authorizes Willy’s Trucking Service to obtain any information required concerning this application and affirm that the information herein is true and correct. The undersigned also acknowledges that account terms are Net 30 days from the date of invoice and interest is charged at 2% (26.82% per annum) on accounts not paid in accordance with the said terms. Failing to make payments in accordance with these terms, Willy’s Trucking Service may take appropriate collection action.

Date:

Print Name:

Position:

01/2020

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Date Approved:

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Credit Limit:

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Rate Sheet:

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Additional notes/comments

For Office Use Only

Edmonton 780.488.2300 ● Fort St John 250.785.2364 ● Grande Prairie 780.830.2300 ● Peace River 780.624.2355