The FAX ENGINEER 4801 Steeles Ave. West Unit # 24 Toronto, Ontario, M9L 2W1 Canada Phone# 416-740-5252 Fax # 416-740-5885 Application for Credit Legal Company Name:__________________________________________Date_____________ Business/ Trade Name: ________________________________________________________ Address: _____________________________________________________________________ Telephone# :( )_________________ Fax #( )____________________ E-mail address: __________________________URL www.____________________________ Year Business Started______________ Legal Status: ___ Incorporated ___Partnership ___ Sole Proprietorship Premises: ___Owned ___ Leased Landlord's Name___________________ Phone#________ PST#________________________________ GST# ______________________________________ Principals and or Officers of Company: Name Title Home Address Telephone 1.___________________________ __________________ _____________________ ____________ 2.___________________________ __________________ _____________________ ____________ 3____________________________ __________________ _____________________ ____________ Account Payable Contact:_______________________________ Telephone ( )________________ Bank:______________________________ Account#________________________ Phone#_________ Branch:__________________________ City:_________________ Fax# ( )____________________ Suppliers/Trade References: 1 ) Name:______________________________ Monthly Purchase:______________________ Address:__________________________________________________________________________ Telephone#( ) ________________ Fax# ( ) __________________________ 2 ) Name: ______________________________ Monthly Purchase:_____________________ Address:__________________________________________________________________________ Telephone#( )_____________________Fax#( )_____________________________ 3 ) Name:__________________________________ Monthly purchase:_________________ Address: _________________________________________________________________________ Telephone#( )________________________Fax#( )_________________________ LINE OF CREDIT REQUESTED : $ _____________ Upon acceptance of this application for credit in the amount required I / WE agree to: 1) The Terms of Sale, Net 30 days, with a charge of 2% interest per month( 24% per annum)on overdue accounts. 2) Personally guarantee payment of any monies owing from the extension of this line of credit. 3) Make additional payments of any further charges arising from the collection of any amounts which become delinquent. Signature:________________________ Name:_________________________ Title____________ Signature:_________________________Name:__________________________Title____________ Date:_____________