WISDOM ELECTRONICS INC.

705 Middlefield Road, Units 101-104, Scarborough, Ontario M1V 5H5 Canada * Tel: (416) 321-3609 * Toll Free: 1-800-790-4686

E-mail: [email protected] * Homepage: http://www.wisdom-wellson.com

CREDIT APPLICATION FORM

PLEASE PRINT CLEARLY & FAX TO (416) 321-0279

BUSINESS INFORMATION:

Company’s Full Legal Name:

Operating Name:

Address:

City:

Province:

Postal Code:

Tel No.:

Fax No.:

Web-site:

Years Established:

# Of Employees:

P.S.T. No.:

G.S.T. No.:

E-mail:

Organization   (       )         Corporation   (       )          Partnership   (       )        Incorporated   (       )        Sole Proprietor   (      )

Please indicate head office address (If different from above):

City:

Province:

Postal Code:

Accounts Payable Contact :

Tel No.:

Ext. No.:

Fax No.:

 

NAME(S) OF PRINCIPAL & TITLE (MUST FILLED):

(1) Owner Name:	Resident Tel No.:	Resident Fax No.:	Resident E-mail:
Resident Address:
(2) Name:	Title:	Tel No.:	Fax No.:
Address:

 

BANK INFORMATION (MUST FILLED):

Name Of Bank/Financial Institution:		Contact Name:
Branch Address:
Tel No.:	Fax No.:	Account No. (REQUIRED):

 

TRADE REFERENCE (ACTIVE):

(1) Company Name:	Contact Name:
Address:	Tel #:	Fax #:
(2) Company Name:	Contact Name:
Address:	Tel #:		Fax #:
(3) Company Name:	Contact Name:
Address:	Tel #:			Fax #:

 

By signing this application, you agree WISDOM ELECTRONICS INC to obtain any reports containing credit or personal information that is required in obtaining credit.  Overdue accounts will incur interest charges at the rate of 18% per annum. Personal Guarantee: By signing this application you agree to be bound personally by the terms of repayment of the business customers obligations.
Authorized  Signature:	Title:	Date:
Full  Name (Print clearly):	S.I.N. #. (REQUIRED):	Driver’s License (REQUIRED):