The Web Source Strapping and Fasteners Ltd.
#106 9706 188 Street, Surrey, B.C. V4N 3M2
Phone: (604) 888-4405
Fax: (604) 888-4108

CREDIT APPLICATION FORM

Legal Name of Company: _________________________________________________________

Address: _______________________________________ City: ________________________

Province: __________ Postal Code: ______________

Telephone No. ____________________________ Fax No. ___________________________

President _______________________________

Accounts Payable Contact: _______________________________

P.S.T. Exemption # __________________________

Credit Amount Requested: $___________________ TERMS: Net 30 days



CREDIT REFERENCES

Company: ___________________________________ Phone : _________________________

Address: ____________________________________ Fax: ____________________________

Contact: ____________________________________

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Company: ___________________________________ Phone: _________________________

Address: ____________________________________ Fax: ___________________________

Contact: ____________________________________

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Company: ___________________________________ Phone: ___________________________

Address: ____________________________________ Fax: _____________________________

Contact: _____________________________________




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