Credit Application

All boxes with a * are required fields.

Company Information

Your Name *

Your Email Address *

Purchasing Contact

Accounts Payable Contact

Accounts Payable Email Address *

Credit Limit Desired *

Company Name *

Billing Address Line #1 *

Billing Address Line #2

Country *

Province / State *

City *

Postal/Zip Code *

Phone *

Fax

Shipping Address *

Same as Billing Address

Will Purchases be BC PST Exempt *

PST Number

Example: 8144-1120

GST/Federal Tax ID (IRS) No. *

Date Company Established *

Business or Industry type *

Principals of Company

Name / Title #1 *

Name / Title #2

Name / Title #3

Bank Information

Bank Name *

Branch Address Line #1 *

Branch Address Line #2

Branch Country *

Branch Province/State *

Branch City *

Branch Postal/Zip Code *

Bank Phone *

Bank Contact Person *

Credit References

Note: Please do not use company/personal references with which your company has any affiliation, or have a "non-arms length" relationship with. Fax numbers and email addresses are required for references. Thank You.

Company Name (1) *

Company Contact (1) *

Phone (1) *

Fax (1)

E-mail address (1) *

Company Name (2) *

Company Contact (2) *

Phone (2) *

Fax (2)

E-mail address (2) *

Company Name (3) *

Company Contact (3) *

Phone (3) *

Fax (3)

E-mail address (3) *

Other Information

How did you hear about us?

Please Read and Acknowledge

The above information is for the purpose of obtaining credit and is warranted to be true. I am aware of Northern Plastics Ltd. credit terms of Net 30 days, and agree to pay all invoices within this time, or as otherwise expressly agreed. I am a legal, bonafide representative of the business applying for credit, and am fully authorized to enter into this agreement on their behalf.

I hereby authorize the person or firm to whom this application is submitted to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirements. This information is provided in confidence to Northern Plastics Ltd. for the purpose of granting the above request for credit.

Your Name *

Your Title *