Draglam Salt

PART I - COMPLETE ONLY IF CUSTOMER IS A CORPORATION
Company Name:		Date Incorporated:	Trade Name(s):
Billing Address Street: City: Province: Postal Code:
Telephone No.		Accounts Payable Person:	Email Address:
Fax No.:	Cell No.:
Names of Directors/officers:	Position:	Telephone No.:	Home Address:
Names of Directors/officers:	Position:	Telephone No.:	Home Address:
Names of Directors/officers:	Position:	Telephone No.:	Home Address:
Name(s) of Related Companies:		Telephone No.:	Address(es):
Province of Business Registration:

PART II - COMPLETE ONLY IF CUSTOMER IS AN INDIVIDUAL OR PARTNERSHIP
Business Name:
Billing Address Street: City: Province: Postal Code:
Telephone No.		Fax No.:	Accounts Payable Person:
Name of Partner or Sole Proprietor:	Home Address:	Telephone No.:	Social Insurance No.:
			Drivers Licence No.:
Name of Partner or Sole Proprietor:	Home Address:	Telephone No.:	Social Insurance No.:
			Drivers Licence No.:
Name of Partner or Sole Proprietor:	Home Address	Telephone No.:	Social Insurance No.:
			Drivers Licence No.:

PART III - TO BE COMPLETED BY ALL CUSTOMERS
Business Premises - Leased or Owned:	If Leased, Name of Landlord:	Landlord’s Address:	Landlord’s Telephone:
GST No.:	PST. Exemption No. (attach copy of Certificate):	Is latest Financial Statement Available? (yes/no):
Have any of your suppliers placed you on C.O.D. in the last 6 months? (yes/no):		If yes, give name and telephone no. of the supplier:
Have you been sued by any of your suppliers in the last 6 months? (yes/no):		If yes, give name and telephone no. of the supplier:

Banking Information:

Name of Bank:

Branch Address:

Contact Person:

Account No.:

Telephone No.:

Fax No.:

Trade References (3 minimum):
Name of Supplier:	Address:	Contact Person:	Email:
		Telephone No.:	Fax No.:
Name of Supplier:	Address:	Contact Person:	Email:
		Telephone No.:	Fax No.:
Name of Supplier:	Address:	Contact Person:	Email:
		Telephone No.:	Fax No.:

TERMS AND CONDITIONS
Upon acceptance of this Application, the Customer may purchase goods on credit, on the following terms and conditions:

Invoiced amounts shall be paid within 30 days of the date of the invoice (the “Due Date”);
Interest on any unpaid invoiced amounts will be charged from the Due Date to the date of payment at 2% per month (24% per annum);
If an invoice is not paid in full by the Due Date, the Customer’s account is deemed to be delinquent;
The Customer agrees to be responsible for all collection costs, including legal fees on a substantial indemnity basis from the date the account became delinquent or is deemed to be delinquent and interest at the rate of 24% per annum shall be payable before and after Judgment;
Notice of any defective or missing product must be delivered in writing to the Company within 24 hours of delivery or the Customer is deemed to have received all ordered product in satisfactory condition;
The Customer agrees that all accounts shall be paid in accordance with the Terms and Conditions set out above and the Customer acknowledges and agrees that the Company reserves the right to withhold, cancel or modify credit privileges at its discretion;
The Company accepts no responsibility for verbal instructions given to its truck drivers; and
The Company shall not be responsible for any delays encountered in the delivery of its products or materials.

The Company may at any time obtain credit information about the Customer from any credit bureau, its employer or any other person in connection with any of the Customer’s dealings with the Company and the Company may disclose (automatically or upon request) credit information about the Customer to credit bureaus and to persons with whom the Customer has or proposes to have financial dealings or if the Company believes disclosure is required by law.

Customer's Signature:_____________________________________		Title:____________________
Print First & Last Name:__________________________ Authorized Signing Officer, Partner or Sole Owner, as the case may be.		Date:____________________
PERSONAL GUARANTEE
I __________________________ agree to be personally responsible for outstanding balances owing to the (Print Name) Company by the Customer.
Signature: _____________________________________	Date:____________________
Witness:__________________________	Social Insurance No.:____________________
	Driver's Licence No.:____________________