Credit Application

Company Name:

Registered As:

Street Address:

City:

Province/State:

Postal/Zip Code:

Country:

Phone:

Fax:

Type of Business:

Proprietorship: Partnership :     

Corporation since:

Accounts Payable Contact:

Accounts Payable Phone #:

Amount of Credit:

Fed. ID #:

D&B#:

Bank (Branch & Address)

Account #:

Bank Contact:

Phone:

Trade References

1) Name:

Street Address:

Zip/Postal Code:

Phone:

State:

Fax:

2) Name:

Street Address:

Zip/Postal Code:

Phone:

State:

Fax:

3) Name:

Street Address:

Zip/Postal Code:

Phone:

State:

Fax:

I understand that Bestwork Industries' terms are NET 30 DAYS of date of invoice, unless otherwise stipulated in writing, and that a service charge of two percent (2%) per month will be paid by the customer on all amounts over these terms. I hereby certify that the information provided is correct to the best of my knowledge.

I hereby authorize Bestwork Industries to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business requirement.

Signature 

Name of Principal Officer:

Title: