Print, complete the form and email to sales@orioncomputer.ca.
NEW ACCOUNT/CREDIT APPLICATION FORM
COMPANY PROFILE
Company Name: __________________________________________________________________________
Business Address: ________________________________________________________________________
Telephone: __________________________________ Email: ______________________________________
Date Business Established: _____________________
Owner: _____________________ Telephone: _____________________ Email: _____________________
Social Insurance Number: _____________________ % of Ownership: _____________________
BANK REFERENCE
Bank Name: _____________________ Address: _____________________
Telephone: _____________________ FAX: _____________________Contact: _____________________
Account Number: _____________________ Transit#: _____________________
CREDIT REQUEST
Requested Credit Line: _____________________
Requested Terms: _____________________
TRADE REFERENCE
Company Name: _____________________ Contact: _____________________
Telephone: _____________________ Address: _____________________
I hereby certify that the information contained herein is true and correct, and grant vendor permission to verify all information. Further I hereby authorize the bank and trade references listed in this application to release the information necessary to assist ORION COMPUTER & ELECTRONICS in establishing an account for our company.
Authorized Signature: ____________________ Title: ____________________ Date: ____________________