Credit Application

Legal Name of Applicant: *

Please specify your Trading Name: *

Please specify the branch nearest to your location: *

Are PO #'s required when ordering?: *

Yes

Have you ever had an Account with Pro Body Parts?: *

Yes

How many years have you been in business?: *

Are you a member of a Buying Group?: *

Yes

Please specify your business type: *

Please provide your GST/HST number: *

Please provide your PST number: *

Business Information

Billing Address

Street: *

City: *

Provice: *

Postal Code: *

Shipping Address

Street: *

City: *

Provice: *

Postal Code: *

Owner Details

First Name: *

Last Name: *

Home Street: *

Home City: *

Province: *

Postal Code: *

Home Telephone: *

Email Address: *

Accounts Payable Details

First Name: *

Last Name: *

Telephone: *

Email Address: *

Trade Reference Details

Reference #1

Vendor Name: *

Years of Business Relationship: *

Telephone: *

Facsmile: *

Reference #2

Vendor Name: *

Years of Business Relationship: *

Telephone: *

Facsmile: *

Reference #3

Vendor Name: *

Years of Business Relationship: *

Telephone: *

Facsmile: *

IN CONSIDERATION OF BEING ALLOWED TO OBTAIN GOODS OR MATERIALS FROM PRO BODY PARTS, I/WE DO HEREBY AGREE JOINTLY AND SEVERALLY AS FOLLOWS:

THE INFORMATION GIVEN IS WARRANTED TO BE TRUE AND IS GIVEN FOR THE PURPOSE OF OBTAINING CREDIT TO PAY ALL PRO BODY PARTS INVOICES IN ACCORDANCE WITH THE PAYMENT TERMS.
ALL PAYMENTS ARE DUE ON THE 15TH OF THE MONTH FOLLOWING.
THAT PRO BODY PARTS MAY AT ANY TIME AT ITS DISCRETION SUSPEND FURTHER CREDIT PRIVILEGES TO ME/US.
TO AUTHORIZE PRO BODY PARTS OR THEIR AGENTS TO OBTAIN CREDIT INFORMATION ON THE COMPANY, OWNER AND/OR PRINCIPAL SHAREHOLDER FROM EQUIFAX AND OTHER SOURCES.
PAST DUE ACCOUNTS MAY BE SUBJECT TO A SERVICE CHARGE OF 1.5% COMPOUNDED MONTHLY (19.65% PER ANNUM).

Authorization Provided by: *

Please type name.