CUSTOMER CREDIT APPLICATION

Please complete the following form to apply for credit with Leech Printing Ltd. Fields marked with * are required.

Company Information
Company/Business Name*
Operating or Trade Name*
Years in Business*
Physical Address*
Street Address Address Line 2 City Province Postal Code
Is your mailing address the same as your physical address?*
- Yes
- No
Mailing Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Fax
Provincial Tax Number
Provide your Provincial Tax Number if you are tax exempt.
Accounts Payable Contact Name*
Phone*
Email*
Credit Limit Requested*
Number of Operating Locations*
P.O. Number Required*
Does your account department require the use of a P.O. number when making purchase from suppliers?
- Yes
- No
Company Officers/Owners*
Use the +/- at the end of each line to add or remove company officers/owners.
Name Address Title Ownership %
The customer:
A. Authorizes Leech Printing Ltd. to investigate the customer's credit history and ability to pay. The customer consents to all such investigations and inquiries as may be made by Leech Printing Ltd. to obtain credit information.

B. Acknowledges the terms of purchase are as follows: INITIAl ORDER: minimum 50% deposit (amount subject to discretion of Leech Printing Ltd.) with order and balance due on delivery. SUBSEQUENT ORDERS: Net 30 days. Interest will be charged on overdue amount at the rate of 2% per month, 24% per annum.

C. Acknowledges that the credit information provided on the credit application form and all other credit information given by the customer to Leech Printing Ltd. in the course of the customer's application for credit is complete and accurate in all material respects and that such information is being relied upon for the purpose of granting credit.
Signed on:*
Date Format: YYYY dash MM dash DD
Signature
Title:*
Provide your job title or position within your company.
References (3 Required)
I/we do business on an open account with the following firms:
Reference #1 - Name*
Phone*
Email*
Fax*
Address*
Street Address Address Line 2 City Province Postal Code
Reference #2 - Name*
Phone*
Email*
Fax*
Address*
Street Address Address Line 2 City Province Postal Code
Reference #3 - Name*
Phone*
Email*
Fax*
Address*
Street Address Address Line 2 City Province Postal Code
Email
This field is for validation purposes and should be left unchanged.

Name	Address	Title	Ownership %

CUSTOMER CREDIT APPLICATION

Company Information

The customer:

References (3 Required)