Royce//Ayr

Credit Application Form
& Agreement

You must complete the form below in order for your application to be processed. Ontario Businesses 'MUST' fill out a PST exemption form in order to receive exemption status.

Click here to fill out a PST form.

* indicates areas that MUST be filled in before proceeding with application

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 Officers		Title
		Title
Nature of Business

# of Employees
*PST#
Federal ID# (U.S. Customs 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? Yes No
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

*Click here to read the terms and conditions
I understand and agree to the terms and conditions

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