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ACTION Credit Application
Credit Terms
You call on us to deliver very quickly and we always give it our best. In return we ask that you pay us very quickly as well.
Name of Business & Address
  Legal Name of Company *   Phone *
  Trade Name   Fax
  Email Address *   GST Number *
  Street *   City *
  Province *   Postal Code *
  Established Date   Nature of Business
Billing Address (if different)
  Street   City
  Province   Postal Code
Form of Business
  Proprietorship Partnership Corporation Other
Describe if Other
Full Name and Address of Owner and Partner (if other than corporation)
  Name   Address
  Name   Address
Other Company Information
  Name of Parent Company & Affilation (if any)   Nature of Business
  Date Business Started   Number of Employees
Premises (Check Appropirate Box)
  Owned Rented        
Landlord Information (if Rented)
  Name   Phone
Bank References
  Bank Name and Branch Number *   Phone *
  Address *   Account Number*
  Bank Contact   Title
  Chequing  Saving Chequing & Saving    
Trade References (minimum of 3 are required)
  Trade Reference Name * Address * Phone *
I hereby represent that I am authorized to submit the application on behalf of the customer named above, and that the information provided for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize Action to investigate the references listed pertaining to my my/our credit and financial responsibility. It is agreed and understood that all the necessary collection and legal and interest (at 26.82% per annum maximum) may be charged to my company in the event of default or failure to pay for services rendered. I/we further represent that the customer applying for the credit has the financial ability and willingness to pay for all the invoices within the established terms.
The undersigned (A) certify all the information above to be true and complete, (B) authorize and consent to the receipt and provision of account and credit information from and to the Credit Grantors, Credit Bureaux, and Supplies of Service.
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