Customer Information Form - DOC by NikFozzar

VIEWS: 379 PAGES: 2

									                                       CRP PRODUCTS INC
                       341 Lorne Ave. E.  Stratford  Ontario  CANADA N5A 6S4
                              Phone: 1.519.271.1283  Fax: 1.519.271.8544

                               Customer Information Form

Trade Name:                                                                  EIN#
Address:                                                                  PST#
Telephone:                                          FAX#
Name of AP Contact Person:                                                Email
Title:
Telephone:                                          FAX#
Approximate Annual Sales:                           Credit Line Requested:



                                         OWNERSHIP
Name:
Title:
Address:
Ownership %:                                   Telephone:



         LIST PEOPLE AUTHORIZED TO CHARGE TO YOUR ACCOUNT
                      Name:                                 Position                Phone
1
2



                                    BANK REFERENCE
Bank:                                                           Branch:
Address:
Account Number(s):
Telephone:                                                      Ext:
Officer:                                                        Title:



                       CREDIT CARDS (copy of front & back required)
Bank:                                               Bank:
Number:                                             Number:
              Visa   Master Card                             Visa   Master Card 
Name on Card:                                       Name on Card:


Project: 20236684                          Page 1                                        6/23/2009
                                        CRP PRODUCTS INC
                       341 Lorne Ave. E.  Stratford  Ontario  CANADA N5A 6S4
                              Phone: 1.519.271.1283  Fax: 1.519.271.8544

                                Customer Information Form



                                          REFERENCES
COMPANY NAME:                                      PHONE :
CONTACT:                                           FAX:
COMPANY NAME:                                      PHONE:
CONTACT:                                           FAX:



Terms:
1   Payment by the Purchaser shall be made according to the terms specified on the Invoice.
2   A service charge of 2% per month cumulated monthly will be charged on overdue accounts from the
    date of the Invoice until the Invoice has been paid. Plus their may be a charge for the fee charged by
    an outside legal or quasi-legal service hired to assist with collection of any overdue amount.
3   We reserve the right to hold orders, change the set terms, &/or cancel credit, at any time or for any
    order.
4   Title for all goods purchased remains the property of CRP Products until paid in full.
5   I/We authorize CRP Products to obtain any information required concerning the statement and
    application hereon. I/We hereby affirm that the information herein given for the purpose of obtaining
    Credit, can be relied upon as being true and accurate.
6   You are hereby authorized to charge my credit card(s) as listed above for amounts overdue by more
    than 30 days. It is understood that all charges to credit card(s) are irrevocable and nonrefundable.
    I/We also understand that I/We will be held personably liable for any overdue accounts by 90 days(if
    prior payment arrangements have not been made).
7   I/We acknowledge by our signature below that I/We are subject to CRP Products Terms.


CREDIT CANNOT BE                Authorized Signature:
EXTENDED UNTIL
THIS FORM IS
COMPLETED AND
VERIFIED:                       Title: _______________________            Date: _________________




Project: 20236684                            Page 2                                             6/23/2009

								
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