Who Are We

NEW CUSTOMER INFORMATION
Name of Customer
Full legal name
Operating as name (if different)

Billing Address
City
Province or State
Postal Code or Zip Code
Accounts Payable Contact
Phone number
Fax number
E-mail address

Shipping Address
City
Province or State
Postal Code or Zip Code
Purchasing Contact Name
Purchasing Phone number
Purchasing Fax Number
Purchasing E-mail address

Do you have more shipping addresses? Yes
If you do, please submit here:
Type of organization
Incorporated Business Unincorporated Business Other
What is your major product or service?

Do you require Purchase Order #s to be used?
Yes No

Credit Information
Number of employees
Number of years in business
Name of principal/owner: Title:
Do you own or rent?	Own Rent
Present Landlord

Name of Bank
Branch address
Branch city
Account number	Transit #

Supplier References
No.	NAME	PHONE #	FAX #
1
2
3
4
By submitting this application for a charge account I certify that the above information is true and give Wood Mountain Services INC. permission to conduct a credit inquiry. I agree to payment terms of net 30 days from the date of invoice. I agree that all overdue accounts will be charged interest at a rate of 2% per month from the due date and to pay all legal and collection costs. I agree to pay a $25.00 fee for any cheque returned, dishonored by my bank.

Applicant
Name:		Title:
Do you agree with these application terms?
Yes No