Credit Application Form

CREDIT APPLICATION FOR NEW CUSTOMER

Company Legal Name:*

Company Trade Name:*

Street Address:*

City:*

Province:*

Postal Code:*

Phone* #

Fax #

Email Address:*

OWNER INFORMATION

Owners Name:*

Owners Home Address:*

Owners Home Phone* #

Owners Cell Phone* #

OTHER INFORMATION

Financial Institution Including Address:

Phone #

GST/HST Registration #*

Provincial Sales Tax #:*

Amount of Credit Required:*

Expected Sales Volume Per Year:

Fiscal Year End:

Month

Year

Are you part of a Buy Group

Bank Account Information(please provide void cheque)*:

CREDIT / TRADE REFERENCE

Credit/Trade Reference 1:

Company Name*:

Address*:

Name of Contact*:

Email of Contact*:

Phone/Mobile number*:

Credit/Trade Reference 2:

Company Name*:

Address*:

Name of Contact*:

Email of Contact*:

Phone/Mobile number*:

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ADD CONTACT LIST

Statements

Name:

Email:

Invoices

Name:

Email:

Price Pages

Name:

Email:

Order Confirmation

Name:

Email:

Automatic Notification: Back Order Arrival

Name:

Email:

Automatic Notification: ETA Date Change

Name:

Email:

Purchasing Agents

Name:

Email:

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PRIMCO ONLINE USER REGISTRATION

Submission Date*:

Customer Number:

Company Name:

Administrator Will See:

Account Details, Including Credit Details
Invoices(Open/Closed/Credit Memos)
Pricelists
Quotes
Purchases
Prices

Administrator:

First & Last Name*

Email*

Standard User:

Name(First & Last):

User Email:

Name(First & Last):

User Email:

Name(First & Last):

User Email:

Name(First & Last):

User Email:

Standard User Options:

Can See Account Details*

Can See Placed Order*

Can See Invoiced Order*

Can See Credit Memos*

Can See Prices*

Can See Price List*

Date*

Title*

Print Name*

Signature*

YES, I want to receive future sales and marketing emails from Primco and as signing authority for the Company, I give permission for Primco to send ALL email addresses listed on this page sales and marketing related emails.

* Mandatory Fields

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