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Online Credit Application

CONTACT INFORMATION

FIRST NAME*

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LAST NAME*

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PHONE #*

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XXX-XXX-XXXX

EMAIL*

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HOW WOULD YOU LIKE TO SUBMIT THE APPLICATION?*

BY FILLING AN ONLINE FORM (CONTINUED)

BY UPLOADING AN EXISTING PDF FILE

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BUSINESS INFORMATION

NAME OF BUSINESS*

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LEGAL (IF DIFFERENT)

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ADDRESS*

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CITY*

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PROVINCE/STATE*

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POSTAL/ZIP CODE*

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PHONE #*

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XXX-XXX-XXXX

FAX #*

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XXX-XXX-XXXX

E-MAIL ADDRESS*

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WEBSITE*

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DESCRIPTION OF BUSINESS

P.S.T. LICENSE#*

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CREDIT REQUESTED*

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DATE OF INCORPORATED OR ACTIVE PERIOD*

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BUSINESS STRUCTURE*

CORPORATION

PARTNERSHIP

PROPRIETORSHIP

DIVISION/SUBSIDIARY

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PARENT COMPANY

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BANK REFERENCES

NAME OF BANK*

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CONTACT NAME*

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BRANCH*

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ADDRESS*

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ACCOUNT#*

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PHONE #*

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XXX-XXX-XXXX

ACCOUNTANT’S DETAILS

NAME*

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PHONE #*

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XXX-XXX-XXXX

LAWYER’S DETAILS

NAME*

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PHONE #*

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XXX-XXX-XXXX

DUNN INFORMATION

DUNN NUMBER*

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COMMERCIAL REFERENCES (3 REQUIRED)

NAME OF BUSINESS*

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CONTACT NAME*

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ADDRESS*

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CITY*

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PROV./STATE*

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PHONE #*

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XXX-XXX-XXXX

NAME OF BUSINESS*

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CONTACT NAME*

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ADDRESS*

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CITY*

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PROV./STATE*

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PHONE #*

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XXX-XXX-XXXX

NAME OF BUSINESS*

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CONTACT NAME*

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ADDRESS*

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CITY*

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PROV./STATE*

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PHONE #*

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XXX-XXX-XXXX

UPLOAD EXISTING FORM(-S)

Maximum file size: 2MB. Allowed extensions: PDF, PNG, JPG

FILE #1*

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FILE #2

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FILE #3

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CONFIRMATION OF INFORMATION ACCURACY AND RELEASE FOR AUTHORITY TO VERIFY*

It is understood and agreed that all invoices will be paid within terms: Net 30 days. When failure to do so occurs, interest is charged on overdue accounts and Winmagic Inc. has the right to place a lien on materials until such accounts are settled. It is also understood that Winmagic Inc. will make every reasonable effort to avoid loss or damage to materials, but liability is limited to the stock cost of the original materials. I hereby certify that the information in this credit application is correct.

Please select/check the field if you confirm the accuracy of application.