Jagreen

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JaGreen Enterprises Ltd

130 Industry St. Unit 31 & 32, Toronto ON Canada M6M 5G3

Tel: 888-418-7565 / 416-335 -9625 Fax:

CREDIT APPLICATION FORM

COMPANY NAME:

ADDRESS:

CITY:

PROVINCE:

POSTAL CODE:

TELEPHONE:

FAX:

EMAIL:

OWNERSHIP (Check applicable Box)

Sole Proprietorship

Partnership

Corporation

Number of years in business:

Number of Location(s):

Business Registration Number:

NAME OF OWNERS/BUYER/ACCOUNTS PAYABLE CONTACT:

NAME	TITLE	PHONE NUMBER	EMAIL

CGTA MEMBER:

YES

BANK INFORMATION

Name of Bank:

Phone No:

Address:

Account # :

GST/HST# :

FOR NEW ACCOUNTS, THE FULL AMOUNT OF INITIAL ORDERS SHALL BE PREPAID BY CASH, CHEQUE, OR CREDIT CARD (VISA OR MASTERCARD). CUSTOMERS SHALL BE CONSIDERED FOR CREDIT AFTER A CREDITABLE TRADING PATTERN AND PAYMENT HISTORY HAS BEEN ESTABLISHED.

NAME

CITY / PROVINCE

TEL#

FAX#

EMAIL#

NAME

CITY / PROVINCE

TEL#

FAX#

EMAIL#

NAME

CITY / PROVINCE

TEL#

FAX#

EMAIL#

NAME

CITY / PROVINCE

TEL#

FAX#

EMAIL#

SIGNING OFFICER

NAME & TITLE

DATE

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