Registered
Name:___________________________________________________________________
Operating
Name:_______________________________________________________________________
Street
Address:________________________________________________________________________
City:_________________________________ Province:___________________ Postal
Code:__________
Phone:___________________ Phone 2:_____________________ Phone
3:________________________
Fax:_____________________ Fax 2:_______________________ email:
__________________________
Company Bank ________________________________________________________________________
Street Address _________________________________________________________________________
City ____________________________________ Province______________ Ph____________________
Account # _____________________________________ Contact_________________________________
#1 REFERENCE #2 REFERENCE #3 REFERENCE
___________________________ ___________________________ ______________________
___________________________ ___________________________ ______________________
___________________________ ____________________________ ______________________
PH ________________________ PH _________________________ PH____________________
FAX_______________________ FAX________________________ FAX__________________
Applicant hereby agrees that all
charges are payable according to our invoice unless otherwise pre-arranged with
our credit department. A 20% re-stocking fee will be charged on all returned
items. Should it become necessary for Bee Cee Wicks & Wax to file suit to
enforce payment of any charges, applicant agrees to pay court costs, attorney
fees, and interest at 2% per month on all amounts found to be due and payable.
I hereby certify the foregoing to be
true to the best of my knowledge and agree to the terms above.
Date _______________________________
] PLEASE FAX COMPLETED FORM AND ANY ADDITIONAL DOCUMENTS TO 604-294-1231