Credit Application

BUSINESS CONTACT INFORMATION

*Contact Name

Position/Title

*Company Name

*Company Address

*City

*Province/State

*Postal/Zip

*Phone #

Ext.#

*Fax

*Email

*Date Business Commenced

*Company Type

If Other Please Elaborate

BUSINESS AND CREDIT INFORMATION

*Primary Business Address

*City

*Province/State

*Postal/Zip

*Email

How Long at Current Address

*Phone #

Ext.#

Fax

Banking Information

*Bank Name

Accounts Payable Contact

*Address

*City

*Province/State

*Postal/Zip

*Phone #

Fax

*Account Number

*Transit Number

PST (If Applicable)

Credit Limit Request

Click If You Require Monthly Statements

BUSINESS/TRADE REFERENCES

Reference (1)

*Company

*Email

*Address

*City

*Province/State

*Postal/Zip

*Phone

Fax

Reference (2)

*Company

*Email

*Address

*City

*Province/State

*Postal/Zip

*Phone

Fax

Reference (3)

*Company

*Email

*Address

*City

*Province/State

*Postal/Zip

*Phone Number

Fax

AGREEMENT

All invoices are to be paid 30 days from the date of the invoice.
Claims arising from invoices must be made within 7 working days.
By submitting this on-line application, you authorize Highlight Motor Group Inc to make inquiries into the banking and business/trade references that you have supplied.

*I fully read and agree with the terms & conditions stated below.