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APPLICATION FOR CREDIT

Please complete this application form, or download it and fax back to 604-295-8171, for review. All fields are required. We will contact you upon review of the application.

Printable Version 
COMPANY INFORMATION
Legal Name of Company:
Business Operating Name:
Contact Name:
Title:
Billing Address:
City:
Postal Code:
Province:
Country:
Tel:
Fax:
Email:
Website:
Shipping Address (if different):
Business Licence No:
GST/HST:
PST/Tax ID:
IRS# (US):
Nature of Business:
Years in Business:
Annual Volume of Business:
Net Worth:
Business status:
Have you ever filed for bankruptcy?
Has a company of which you were director or owner ever filed bankruptcy?
A/C Payable Contact Name:
Tel:
Name of Owner (if Proprietor):
Tel:
 
Cell:
COMPANY'S BANK INFORMATION
Bank:
Address:
Tel:
Fax:
Account #:
Account Name:
Account Manager:
Contact #:
COMPANY'S TRADE REFERENCES
1.
Business Name:
Contact:
Address:
Email:
Tel:
Fax:
 
2.
Business Name:
Contact:
Address:
Email:
Tel:
Fax:
 
3.
Business Name:
Contact:
Address:
Email:
Tel:
Fax:
 
Estimated Monthly Credit Requirement:

 
The above information is for the purpose of obtaining credit and is warranted to be true. All information will be kept in the strictest confidence.

I/we hereby authorize the person or firm to whom this application is submitted 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. I/we acknowledge and accept the terms and conditions of Hutchison Imports and agree to pay all amounts due for goods supplied by Hutchison Imports as and when the amounts become due and payable.

In the event that payments are not made in accordance with the credit policy as stated on the invoice, I/we hereby authorize the charges to be made to my current credit card:

VISA / MASTERCARD Card Number:
Exp Date:
 / 
Name on Card:


The undersigned consent(s) to disclosure of personal information held by any party pursuant to the protection of privacy and freedom of information act.

Authorized Signatory:
Title:
Company:
Date:
October 23rd, 2017






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