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Credit Application
PROFILE>
Complete this section in full.
REGISTERED NAME OR COMPANY
TRADING NAME (IF DIFFERENT FROM REGISTERED NAME)
BUSINESS ADDRESS
CITY
PROVINCE
POSTAL CODE
BILLING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY
PROVINCE
POSTAL CODE
PRODUCTION CONTACT
EMAIL
PHONE
ACCOUNTS PAYABLE CONTACT
EMAIL
PHONE
TYPE OF BUSINESS
PO REQUIRED?
Yes
No
JOB NAME REQUIRED?
Yes
No
FAX
REFERENCES>
Complete this section if applying for 30-day credit terms
Reference #1
TRADE REFERENCE
CONTACT NAME
EMAIL (REQUIRED)
PHONE
Reference #2
TRADE REFERENCE
CONTACT NAME
EMAIL (REQUIRED)
PHONE
AUTHORIZATION>
The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize Astley Gilbert to investigate the references listed pertaining to my/our credit for financial responsibility.
I/We understand the terms by which Astley Gilbert grants credit requires
payment in full within 30 days
.
AUTHORIZED SIGNATURE
TITLE