LEGAL NAME OF THE COMPANY by psq21886

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									PRICELINE AUTO PARTS                                                                                                                              FOR INTERNAL USE ONLY
A DIVISION OF MARITIME EXHAUST LTD
35 ENGLISH DRIVE                                                                                                                                  PRICE CODE: ___________________
MONCTON, NB E1E 3X3
                                                                                                                                                  SALESMAN: ___________________
TEL: (506) 857-8733 OR 1-800-561-7896
FAX: (506) 857-0171

CREDIT APPLICATION
LEGAL NAME OF THE COMPANY:                                                                             STATUS:
                                                                                                       PROPRIETORSHIP _____ CORPORATION _____ PARTNERSHIP _____
MAILING ADDRESS:                                                                                       PRESIDENT OR ASSOCIATE:


PHONE:                                             FAX:                                                VICE-PRESIDENT OR ASSOCIATE

E-MAIL:                                                                                                SECRETARY OR ASSOCIATE

SHIPPING ADDRESS:                                                                                      LINE OF BUSINESS:
                                                                                                       CREATION DATE:
                                                                                                       ANNUAL SALES FIGURES:
IF CUSTOMER IS BRANCH, DIVISION OR SUBSIDIARY, SHOW H.O. ADDRESS & PARENT COMPANY NAME:



CREDITED REQUESTED:

GENERAL INFORMATION                                                                                    P. O. REQUIRED: YES ___ NO ___
ESTIMATED MONTHLY PURCHASES:

ACCOUNTS PAYABLE:                                                                                      PURCHASER:

BANK REFERENCE
BANK:                                                                                                  ACCOUNT #:

ADDRESS:                                                                                               PHONE:

SUPPLIERS:

NAME:                                                               REFERENCE:                                                          PHONE:
                                                                                                                                        FAX:
NAME:                                                               REFERENCE:                                                          PHONE:
                                                                                                                                        FAX:
NAME:                                                               REFERENCE:                                                          PHONE:
                                                                                                                                        FAX:
SALES CONDITIONS:
     1.    Net 30
     2.    The client, through his authorized representative, requests that an account be opened in his name.
     3.    The customer agrees and adheres to all terms and conditions that appear on the invoices and purchase orders. If terms and conditions are not respected, the customer agrees to pay
           administrative fees of 2 % per month (24 % yearly) to be added to the sums owed.
     4.    If default of payment occurs, the customer accepts that supplementary fees of 20% on the outstanding balance shall be levied, if the file has to be referred to a third party, collection agency
           and/or attorney.
     5.    Any legal suits between parties shall be submitted before the court that has jurisdiction within the supplier’s district.
     6.    All unpaid merchandise remains the property of the supplier until full and complete payments has been deposited and funds have cleared.
     7.    I, the undersigned, declare to be jointly and personally responsible for the payment of any sum due or that could be due and we declare not to renounce, by the present, the benefits of
           discussion, division or subrogation.
By the following, the signatory, for all and in the name of the client, declares being fully authorized to request the above representations. He is giving you
the authorization to obtain from all parties, all organizations, all information agencies and/or financial institution reports of solvency and/or credit or any
other relevant information. He is also authorizing these parties to divulge the information, which is pertaining to your credit status.

The signatory has read the sales conditions and accepts them completely.
Signed at: _______________________________________                    Date: _______________________________________________

________________________________________________                                            _____________________________________________________
Signing Authority                                                                           Applicant’s name and t itle in print characters


FOR INTERNAL USE ONLY

CREDIT GRANTED: __________________________________________                               PER :________________________________________________________________

CREDIT REFUSED: __________________________________________                              TITLE: ______________________________________________________________

								
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