CREDIT APPLICATION

 

RETURN VIA FAX: 1-866-565-3251                                       MUST BE COMPLETED IN FULL TO PROCESS

 

________________________________________________________________________________________________COMPANY LEGAL NAME & TRADE NAME        AREA CODE    PHONE NUMBER       FAX NUMBER

 

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MAILING ADDRESS                                                   CITY                PROV.                            POSTAL CODE

 

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SHIPPING ADDRESS (IF DIFFERENT)                    CITY                PROV.                            POSTAL CODE

 

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PST LICENSE NUMBER                                                                           GST NUMBER               

 

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OWNER’S NAME                                HOME ADDRESS                          AREA CODE       PHONE NUMBER

 

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HOW LONG IN BUSINESS   PO REQUIRED   Y/N       LIMIT REQUESTED      EST. MONTHLY PURCHASES        

 

TRADE REFERENCES:  PLEASE NOTE THIS SECTION MUST BE COMPLETED IN FULL TO PROCESS

SUPPLIER NAME                                  CONTACT NAME                             PH.:  NUMBER          FAX NUMBER

 

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2.______________________________________________________________________________________________

 

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BANK REFERENCE

 

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BANK                                                  BRANCH                                                                 PHONE NUMBER

 

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LINE OF CREDIT                               AMOUNT                                        ACCOUNT MANAGER

 

IN CONSIDERATION OF BEING ALLOWED TO OBTAIN GOODS OR MATERIALS ON CREDIT FROM QRP  CANDA MEMBERS, I/WE DO HEREBY AGREE JOINTLY AND SEVERALLY AS FOLLOWS:

 

1.        THE INFORMATION GIVEN IS WARRANTED TO BE TRUE AND IS GIVEN FOR THE PURPOSE OF OBTAINING CREDIT TO PAY ALL QRP CANADA MEMBERS INVOICES IN ACCORDANCE WITH THE PAYMENT TERMS

  1. ALL PAYMENTS ARE DUE ON RECEIPT OF MONTHLY STATEMENT
  2. THAT  QRP CANDA MEMBERS MAY AT ANY TIME AT ITS DISCRETION SUSPEND FURTHER CREDIT PRIVILEGES TO ME/US
  3. TO AUTHORIZE QRCANADA P MEMBERS OR THEIR AGENTS TO OBTAIN CREDIT INFORMATION ON THE COMPANY, OWNER AND/OR PRINCIPAL SHAREHOLDER FROM EQUIFAX AND OTHER SOURCES
  4. PAST DUE ACCOUNTS MAY BE SUBJECT TO A SERVICE CHARGE OF 1.5% PER  MONTH OR 18% PER YEAR.
  5. ALL RETURNS MUST BE MADE IN ACCORDANCE WITH THE WARRANTY TERMS PRINTED ON THE REVERSE OF THE QRP CANADA MEMBERS INVOICE.
  6. RESTOCKING CHARGES MAY APPLY.

 

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE, AND I ACKNOWLEDGE RECEIPT OF QRP  CADADA MEMBERS TERMS OF SALE

 

 

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DATE          SIGNATURE OF OWNER(S)                PRINT NAME(S)                 TITLE