Canadian Credit Application

Phone

This field is for validation purposes and should be left unchanged.

All fields marked with an asterisk (*) are required.

Business Information

Requested Credit Limit*

Sales Representative

Legal Name of Business*

Trade Name (If different)*

Business Type*

Date Registered or Incorporated*

How many years in business?*

Business Address*

Street Address Address Line 2 City Province / Region ZIP / Postal Code

Business Phone

Business Fax

Billing Email*

Enter Email Confirm Email

(Invoices will be emailed)

Accounts Payable Phone*

Accounts Payable Fax*

PRINCIPALS/OWNERS OF BUSINESS

Names of Principals/Owners #1*

Principals/Owners #1 Residential Address*

Principals/Owners #1 Cell Phone Number*

Names of Principals/Owners #2

Principals/Owners #2 Residential Address*

Principals/Owners #2 Cell Phone Number*

BANK REFERENCE

Bank Name*

Account Number*

Full Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name*

Phone Number*

TRADE REFERENCES

(PLEASE PROVIDE THREE REFERENCES – MANDATORY)

Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Fax Number*

Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Fax Number*

Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Fax Number*

CREDIT REQUESTED FOR WHICH OF THE FOLLOWING WALKER COMPANIES / DIVISIONS*

Upon acceptance of this application, the customer may purchase goods on credit, up to the limit set by Walker Industries and/or any of its subsidiaries on the following terms and conditions:

invoiced amounts shall be paid within 30 days of the date of the invoice (the “Due Date”)
interest on any unpaid invoiced amount will be charged from the due date to the date of payment at 2% per month (26.8% per annum)
the customer agrees that all accounts shall be paid in accordance with the Terms and Conditions set out above and the customer acknowledges and agrees that Walker Industries and/or any of its subsidiaries reserve the right to withhold, cancel or modify credit privileges at its discretion
Walker Industries and/or any of its subsidiaries may at any time obtain credit information about the customer from any credit bureau, credit reporting agency, its employer or any other person in connection with any of the customer’s dealings with Walker Industries and/or any of its subsidiaries. Walker Industries and/or any of its subsidiaries may disclose (automatically or upon request) credit information about the customer to credit bureaus and credit reporting agencies and to persons with whom the customer has or proposes to have financial dealings or if Walker Industries and/or any of its subsidiaries believe disclosure is required by law.

NOTICE: A consumer report may be referred to in clearing your application and if the customer is a corporation, a consumer report of the directors, officers or owners of the corporation may also be referred to. The customer consents to the obtaining of such information as Walker Industries and/or its subsidiaries require in connection with the credit applied for or any renewal or extension thereof.

I, the undersigned, agree to the above terms and conditions, declare that all the information supplied in this credit application is true and accurate that I am authorized information supplied in this credit application is true and accurate, that I am authorized to request a charge account at Walker Industries and/or any of its subsidiaries. Furthermore, all bank and trade references indicated are authorized to provide information as may be requested from time to time by the seller or its agent.

Please Print Name*

Please Print Company Name*

Please Print Title*

Date*

Or complete the Canadian Online Credit Application form below

All fields marked with an asterisk (*) are required.

Business Information

PRINCIPALS/OWNERS OF BUSINESS

BANK REFERENCE

TRADE REFERENCES