Credit Application

Company Information
Company Name:
Contact Name:
Contact's Title:
Name of Principal:
Title of Principal:
Address Line 1:
Address Line 2:
Telephone Number:
Cellphone Number:
Fax Number:
Email Address:
PST Exempt License Number:
Name of Owner:
Owner's Date of Birth:
Affiliated Company Name(s):
Banking Information
Name of Bank:
Branch:
Account Number:
Address Line 1:
Address Line 2:
Telephone Number:
Fax Number:
Contact Name:
Contact Title:
Supplier / Reference #1
Company Name:
Complete Address:
Telephone Number:
Fax Number:
Contact Name:
Contact Title:
Supplier / Reference #2
Company Name:
Complete Address:
Telephone Number:
Fax Number:
Contact Name:
Contact Title:
Supplier / Reference #3
Company Name:
Complete Address:
Telephone Number:
Fax Number:
Contact Name:
Contact Title:

Company Terms:	Our terms of sale are net 30 days. Service charges at a rate of 2% per month, 24% per annum will be applied on all past due accounts. I hereby request credit approval for the named company and confirm that the information provided herein is true and that we are in agreement with Duivenvoorden Haulage's terms and conditions. By signing, you are granting Duivenvoorden Haulage Ltd. permission to call the named suppliers/references in order to obtain the credit/account information. You agree that you have signing authority for the company and claim full responsibility for any debts that the company may have with Duivenvoorden Haulage Ltd. or any division thereof.

Company Information