ALTE-REGO CORPORATION
36 TIDEMORE AVENUE
TORONTO, ONTARIO
M9W 5H4
TELEPHONE : (416) 740-3397
FAX : (416) 741-9991
CREDIT APPLICATION FORM
CUSTOMER INFORMATION
LEGAL NAME OF COMPANY (IN FULL)
OPERATING AS (IF APPLICABLE)
STREET ADDRESS
CITY
PROVINCE/STATE
COUNTRY
POSTAL CODE
TELEPHONE #
FAX #
CHECK ONE
CORPORATION
PARTNERSHIP
PROPRIETORSHIP
HOW LONG IN BUSINESS UNDER PRESENT NAME ?
NATURE OF BUSINESS
NAME OF PERSON MAKING THE APPLICATION
ACCOUNT PAYABLE OFFICER
A/P TEL
PRINCIPAL OFFICERS
NAME
TITLE
NAME
TITLE
BANK REFERENCE
NAME OF BANK
CONTACT NAME
ADDRESS
TELEPHONE
TRADE REFERENCES
NAME
ADDRESS
TELEPHONE
FAX
CONTACT
NAME
ADDRESS
TELEPHONE
FAX
CONTACT
NAME
ADDRESS
TELEPHONE
FAX
CONTACT
TERMS AND CONDITIONS

1. The applicant hereby acknowledges that all charges incurred after the establishment of an account shall be considered due and payable thirty (30) days from the date of invoice and that the payment shall be made at this time to the order of ALTE-REGO CORPORATION and forwarded to the designate address.

2. The applicant hereby authorizes ALTE-REGO CORPORATION to perform any credit investigation deemed necessary to establish and maintain a credit account for the applicant. The applicant hereby authorizes the reporting of the above mentioned information and applicant performance to ALTE-REGO CORPORATION or their designates.

3. The applicant hereby consents to abide by all terms and conditions as set out on all invoices. The applicant certifies that the above information is true to the best of their knowledge.
SIGNATURE OF APPLICANT
DATE
(PLEASE SEND A COPY OF YOUR ONTARIO RETAIL SALES TAX PURCHASE EXEMPTION CERTIFICATE)