Amherst Supply

Customer Credit Application

For many contractors, having a credit account makes everyday purchases at our store more convenient. Our application process is straightforward, and credit accounts are due for payment by the 15th of the month following the statement date. The full balance is required, and any outstanding amounts will incur interest. If you're interested in applying for a credit account, please complete the form below.

Business Information

Legal Name

Trading Name

Date of Birth

MM/DD/YYYY

Business Address

Street

City

Postal Code

Mailing Address

Street

City

Postal Code

Physical Location

Year Business EST

Year Business Incorporated

Fax No.

Email Address

Contact Phone Number

Business Phone No.

Fiscal Year End

CorporationSole ProprietorshipPartnership

ESTIMATED PURCHASES (1ST YEAR)

WITHIN 3 YEARS

PRINCIPALS/SHAREHOLDERS

1.

Name

Title

DOB

Home Address

2.

Name

Title

DOB

Home Address

3.

Name

Title

DOB

Home Address

AFFILIATED COMPANIES

1.

Name

Address

Business Phone No.

2.

Name

Address

Business Phone No.

Have you or your shareholders ever owned/managed a company that has been declared bankrupt?

YesNo

Name of Company

Date-of-Bankruptcy

BANK

Account No

Name

Branch No.

Business Phone No.

CREDIT REFERENCE(S)

1.

Name

Address

Business Phone No.

2.

Name

Address

Telephone No.

3.

Name

Address

Telephone No.

PROVINCIAL SALES TAX LICENSE No.

(Sales tax will be charged unless an exception certificate is provided)

Enter No.

GST No.

Enter No.

I/we have the authority to sign for and bind the corporation. I/we consent to Amherst Supply Ltd. obtaining credit information about us personally and about the applicant from third parties at any time during the application process and afterwards. Further, if an account is opened, I/we consent to the disclosure of our credit status with Amherst Supply Ltd. to credit reporting agencies. We represent and warrant that the information in this application is true and correct in all material aspects.

The undersigned consents to the obtaining of such credit information as Amherst Supply Ltd. may require at any time in connection with the credit hereby applied for, or any renewal or extension thereof, and further consents to the disclosure of any information concerning the undersigned to any credit reporting agency, or any person with whom the undersigned has or proposes to have financial relations. I/we also declare that the information disclosed in the application represents a true and accurate presentation of our current financial position in all aspects and will be used to determine the amount and conditions of the credit to be extended.

All invoices are to be paid on/by the 10th day of the following month. Any claims arising from invoices must be made within seven (7) working days of receipt of the product.

Dated At

Weekday

The

Day

Of

Month

20

Year

Enter Signature

APPLICANT'S SIGNATURE