Please fill in all details                                                           Date:

Name:

Address:                                         Postal Code:                      Phone:

City:                 

Former Address:

No. Years at Present Address:

Note: If Billing Address is not the same as above, please indicate on reverse side.

Trade Style:

Company Type:    Limited____    Single Owner____    Partnership____

Name of owners or partners:

When was business established:

What type of business is it?

How long have you lived in the community?

Have you ever filed for bankruptcy either personal or as a principal in a business?    Yes____    No____

List the name, address and telephone number of three or your major suppliers:

1.                                                                                   Phone:

2.                                                                                   Phone:

3.                                                                                   Phone:

Name of your Bank:

Bank Address:

Bank City:                                                                     Postal Code:

Bank Manager:                                                             Phone:

What will be your credit requirements? $                   # orders per week:

CREDIT TERMS:

1. __________ Day.

2. Any price discrepancies or returns must be reported on delivery to the driver, or call the office the same day (905.648.1324).

3. Credits will not be issued after 24 hours.

4. An NSF cheque is an automatic CASH DELIVERY thereafter.

5. Interest at 1.5% per month will be charged on overdue accounts.

Name:(please print) _________________________________Title:__________________  Date:______

Signature: (owner or Credit Manager)____________________________

FOR OFFICE USE ONLY

Owner:                                Credit Manager:                                  Date:

Credit Limit:                        Sales Manager:                                  Date:

PRINT THIS FORM, FILL IN AND FAX BACK TO SOLDAAT'S POULTRY AND MEATS INC. 

(FAX: 905.648.2273)