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#410-3960 Quadra St, Victoria, BC Canada V8X 4A3  Phone: (250) 479-1355  Fax: (250) 479-5777
Credit Application
Company:	_________________________	Ship:	_________________________
Address:	_________________________	Address:	_________________________
City:	_________________________	City:	_________________________
Postal Code:	_________________________	Postal Code:	_________________________
Tel:	_________________________	Fax:	_________________________
Buyer:	_________________________	Ship To:	_________________________
Owner(s):	_________________________	Bill To:	_________________________
Accounts Payable Contact:	_________________________	No. Years in Business:	_________________________
Bank:	_________________________	Account #	_________________________
Address:	_________________________	Contact:	_________________________
City:	_________________________	Tel:	_________________________
Postal Code:	_________________________	Fax:	_________________________
Trade Suppliers References
Name:	_________________________	Contact:	_________________________
Address:	_________________________	Tel:	_________________________
	_________________________
Name:	_________________________	Contact:	_________________________
Address:	_________________________	Tel:	_________________________
	_________________________
Name:	_________________________	Contact:	_________________________
Address:	_________________________	Tel:	_________________________
	_________________________
____________________________		____________________________
Signature & Title		Date
All phone conversations are recorded for accuracy and training.
____________________________		____________________________
Credit Approved		Date

Please print, fill out and fax to us at (250) 479-5777.

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