BORGFELDT (CANADA) LIMITED


                                                                               50 Konrad Crescent, Markham, Ontario, L3R 8T4

                                                           Ph:(905) 946-9677 • Fx:(905) 946-9744 • Email: borgfeldt@idirect.com

           www.borgfeldt.ca • www.LiteHawk.ca • www.Tamiya.ca

 

Credit Application Form

 

Company Name:

 

Billing address (if different)

 

Address:

 

 

 

City

 

Postal Code:

 

 

 

Province:

 

Shipping address (if different)

 

Phone:

 

Fax:

 

 

Contact:

 

 

 

Email:

 

Would  you like to be added to our  news broadcast list?

 

Website

 

Via Fax   ¨                        via email ¨

 

 

 
Profile

 

 

 

Nature of business:

¨  Dealer

¨  Wholesaler

 

 

¨  Dept/Chain

¨  Advertising/Marketing

 

                   

¨  Independent Retail

¨  Manufacturer

 

                   

¨  Gifts

¨  Other __________________________

 

 

 

Years in Business:

 

GST # OR HST#

 

 

Principals in Business:

 

Name

Title

 

 

 

 

 

 

 

 

 

Credit References ( Please provide at least three in industry)

 

 

 

Name

Contact

Fax #  (must provide)

Telephone #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Bank Reference

 

 

 

Name of Bank:

 

 

 

Branch Location:

 

Telephone:

 

 

Branch Manager:

 

Account#:

 

 

 

Terms:

All orders are shipped C.O.D. until terms are established. Subject to credit approval, standard terms are Net 30.

 

Date: ______________________________________             Signature:  _____________________________________________________

 

For Office Use Only

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Salesman

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