Credit Application Form & Agreement

You must complete the form below in order for your application to be processed. We will require a Fed ID# from our US customers.

Contact and Billing Information

Legal Name

Telephone

Fax

Trade Name

Billing Address

City

Province / State

Postal / Zip Code

Shipping Address

How long at this address?

Owned/Rented?

Landlord Name

Landlord Phone

Ownership Detail Information

Principal Owner / Shareholder

Home Address

Other Officer 1

Other Officer 2

Nature of Business

# of Employees

Fed. ID# (U.S. Customers only)

How frequent do you think you will purchase from us?

Frequently (more than once a month
Occasionally (once a month)
Rarely (couple times a year)

Do you require a purchase order?

Terms Desired

2% - 15 days
Net 30 Days
C.O.D.

Credit Desired

Credit Information

Annual Sales $

Name of Bank

Bank Address

Account #

Major Trade References

(this section must be completed in full to be processed. Please check your records for updated phone and fax numbers.)

1. Name of Supplier

Phone

Fax

Address

2. Name of Supplier

Phone

Fax

Address

3. Name of Supplier

Phone

Fax

Address

4. Name of Supplier

Phone

Fax

Address

I understand and agree to the terms and conditions and allow Royce//Ayr to do a complete investigation into my credit history.