Credit Application

complete the following form

This application must be completed in full otherwise credit will not be issued. Please insure all of the information you supply is correct and that you submit the form once you have completed it.

Net 30 days account

Please be aware that you are applying for a NET 30 account.

If this type of account is not for you

Would you like to purchase from WSI but would like to pay for each purchase using a credit card. Then click on the button below to create a CASH ACCOUNT

Name of Company

Name of Person Completing this Application

Trade Name

GST #

Owner

Phone Number (no spaces or - please)

Fax

Business Location

City

Province

Postal Code

Sales Person

Mailing Address

Ship to Address

WSI has consent to email you your monthly statement

Email for monthly statement

Number of Years in Business

Number of Years at Current address

Company is a:

Company Officer #1

Title

Company Officers #2

Title

Accounts Payable (if different than owner)

Accounts Payable Phone

Accounts Payable Email

Authorized Purchasers

Are Purchase Orders Required?

Trade Reference #1

Trade Reference #1 Email

Trade Reference #1 Phone

Trade Reference #1 Fax

Trade Reference #2

Trade Reference #2 Email

Trade Reference #2 Phone

Trade Reference #2 Fax

Trade Reference #3

Trade Reference #3 Email

Trade Reference #3 Phone

Trade Reference #3 Fax

Bank Reference

Bank Address

Name of Contact Person

Bank Reference Email

Bank Reference Phone Number

Credit Limit Requested

I consent to receiving monthly specials and newsletters by email. If you would like them emailed to a different address, then enter it below.

Email for Monthly specials

I/We agree to the terms and Declarations as described below

TERMS: All accounts are due and payable Net 30 days of the month following the purchase. All overdue accounts are subject to the interest rate of 2.0% per month (24% per annum) DECLARATION: I/We confirm that the above information is true and is given for the purchase of obtaining credit. I/We agree to make all of the payments on their due date according to the terms of the sale. I/We further agree to pay all the interest charges on the overdue amounts at the rate of 2% per month (24% per annum). I certify that I am authorized to make this request for credit on behalf of this company/ or my partner(s), and they are aware of this application.