Credit Form | C.H.I. Overhead Doors

Step 1 of 7

Credit Application Form

TO BE COMPLETED BY YOUR ACCOUNTING DEPARTMENT

Representative (*)

Please type your full name.

Phone (*)

Ext

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Account No

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Date (*)

Please select a date when we should contact you.

General Information

Legal Name of Company

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Exemption #

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Affiliated Company (if applicable)

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Physical Address

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Mailing Address

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City

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Country

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Province

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Postal Code

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Phone (*)

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Fax

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Accounts Payable Contact

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Phone (if different)

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Principal Owner

Name

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Address

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City

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Province

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Country

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Postal Code

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Phone

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Fax

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SIN

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Date of Birth

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Banking Information

Bank Name

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Transit

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Account Number

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Address

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City

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Province

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Country

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Postal Code

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Dir. Account

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Phone

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Fax

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Name of your current suppliers

Name

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Credit Limit

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Terms

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Phone

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Fax

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Name

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Credit Limit

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Terms

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Phone

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Fax

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Name

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Credit Limit

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Terms

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Phone

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Fax

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Name

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Credit Limit

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Terms

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Phone

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Fax

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Confirmation

We make application for a credit account with Les Distributions Portes (C.H.I.) Québec Inc. (*) Please acknoledge

I affirm that I am duly authorized to complete the application and confirm the information I have provided is true to the best of my knowledge. (*) Please acknoledge

I authorize Les Distributions Portes (C.H.I.) Québec Inc. to make investigations of our credit standing for which this application is made, as deemed to be necessary by Les Distributions Portes (C.H.I.) Québec Inc. (*) Please acknoledge

Credit Application Form

General Information

Principal Owner

Company Information

Banking Information

Name of your current suppliers

Confirmation