CREDIT APPLICATION

TRANSPORT L. RODRIGUE INC.
186 RUE MONFETTE OUEST, THETFORD MINES QUE. G6G 7Y1
Tél. : 1-418-338-0012 / Fax : 1-418-338-3016 / e-mail : [email protected]
CREDIT APPLICATION
Date :
Cie Name :
Address :
City :
Province :
Postal code :
City :
Province :
Postal code :
Owner (s) name :
Tél. :
In business since :
Fax :
Email :
Personne in charge of payables :
Tél. :
Fax :
Email :
Personne in charge of transport :
Tél. :
Fax :
Email :
Contact in rate departement :
Tél. :
Fax :
Email :
Your Bank Name :
Address :
City :
Tél. :
Province :
Fax. :
Postal Code:
Accompte number:
( 3 ) Supplier’s Names :
1.
2.
3.
Tél. :
Tél. :
Tél. :
Fax :
Fax :
Fax :
Billing address :
Monthly needed credit amount :
Conditions :
1. Terms net 30 days, 2% per month (24% per year ) charged on your overdue account
2. Applicant signature certifies that the above information is correct. As part
of this application for credit,
we grant permission to consumer credit reporting agencies, commercial credit reporting agencies, and
any or all of the trade and bank references listed above. If credit is granted, we agree to pay all bills
within the stated
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TITRE
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SIGNATURE
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DATE