Terms Application Form

Company Background Information

Legal Name

Trade Name

Date Business Started

Business Address

Address Line 1

Address Line 2

City

Provinces

Postal Code

Country

Main Office Phone #

Main Office Fax #

Is your Billing Address different from your Business Address?

YesNo

Billing Address (if different from main address)

Address Line 1

Address Line 2

City

Provinces

Postal Code

Country

Main Office Phone #

Main Office Fax #

Is your Shipping Address different from your Business Address?

YesNo

Shipping Address (if different from billing address)

Address Line 1

Address Line 2

City

Provinces

Postal Code

Country

Do you export products outside of Canada?

YesNo

Business Type

ProprietorshipPartnershipCorporation

If subsidiary and/or division please provide name of parent Company

Principals Names (Owners/Partners/Officers)

Name

Title

Address

City

Province

Postal Code

Banking Information

Name on Account

Bank Name

Bank Routing Number

Bank Account Number

Accounts Payable Contact

Name

Title

Email Address

Telephone

Contact Information