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Section 1 - General Information
Legal Name of Company
Operating Name (if different)
Street Address
City
Province
Postal Code
Billing Address
City
Province
Postal Code
Phone Number
Fax Number
Email Address
Nature of Business
Business Type
Length of Time in Business
GST/Tax ID #
Primary Financial Institution
Location of Financial Institution
Account Contact
Account Number
Section 2 - Account Information
Accounts Payable Contact
Accounts Payable Phone Number
Accounts Payable Fax Number
Credit Amount Requested
Are Purchase Orders Required?
Payments made per
Can you meet our terms of Net 30?
If not, why?
 
 
Preferred payment method and
Section 3 - Officers of The Company
(First) Full Name
(First) Position
(First) Address
(Second) Full Name
(Second) Position
(Second) Address
Section 4 - Credit Refernces
First Reference Name
First Reference Phone
First Reference Fax
Second Reference Name
Second Reference Phone
Second Reference Fax
Third Reference Name
Third Reference Phone
Third Reference Fax
Fourth Reference Name
Fourth Reference Phone
Fourth Reference Fax
Fifth Reference Name
Fifth Reference Phone
Fifth Reference Fax
Terms and Conditions

Credit Terms: All invoices are to be paid Net 30 days

. There are to be no deductions, holdbacks, or offsets of any kind from the amount billed unless prior authorization has been granted.

. Failure to comply with the above terms and conditions will result in cancellation of credit privileges with Varsity Plymouth Chrysler (1994) Ltd. Credit privelleges may be revoked at Varsity's discretion and without notice. Any outstanding balance owing shall become due and payable immediately

. In order to reinstate credit privileges once revoked, payment must be made in full, and a new credit application must be processed.

. Varsity Plymouth Chrysler (1994) Ltd. must be notified promptly of any change in address/ownership.

. Any "NSF" payments may, at our discretion, result in a $20.00 service charge being applied to the account.

. Varsity Plymouth Chrysler (1994) Ltd. may obtain any credit and/or personal information in connection with my/our credit privileges.

. I/We authorize Varsity Plymouth Chrysler (1994) Ltd. to release information pertaining to our credit history and account to other companies seeking this information on our behalf.

I/We have read the above terms and conditions in full.
I/We understand these terms, and agree to abide by them.
I/We herby confirm that I/We have authority to sign on the behalf of this company
Once your application has been reviewed, a member of our parts department will contact you.
Thank you for giving us the chance to earn your business.