Timax Credit Application Form

Basic Billing Information
Legal Firm Name
Usual Trade Name
Address 1
Address 2
City		Province
Postal Code
Phone#		Fax#
Business Information
Description of Business
Type of Organization:	Sole Proprietorship	Partnership	Limited Company
Age of Business:	Less Than 1 year	1-3 years	Over 3 years
Name of Proprietor/Partners/Principal Officers
Name 1		Address
Phone
Name 2		Address
Phone
Name of Bank		Branch
Contact		Phone#
Credit References
Acct Payable Contact		Phone#
Monthly Courier Volume $		Fax#
Email
Please supply the name, address, telephone & fax numbers of three suppliers with whom you enjoy credit privileges.
Reference 1:
Company Name		City
Phone#		Fax#
Reference 2:
Company Name		City
Phone#		Fax#
Reference 3:
Company Name		City
Phone#		Fax#