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Credit Application

Business Information
Credit Margin Required:
Company Name:
  Corporation     Partnership     Proprietorship
Address:
City:
Province:
Postal Code:
   
Main Phone:
Fax:
Web Site:
   
Type of Business:
Years in Business:
Applicant Information
Applicant Name: Phone:
Title: E-mail:
       
Corp Officer Name 1: Title:
Corp Officer Name 2: Title:
Corp Officer Name 3: Title:
       
Accounts Payable Officer: E-mail:
 
 Who to Contact About Purchasing Our Services?
Name: Phone:
Position: E-mail:
Dominion Blue Information
What services are you interested in?
Black & White CAD Plotting Outdoor / Indoor Signage and Banners Web Based Document Fulfillment
Colour CAD Plotting Copy Centre / Bindery Variable Data
Small or Large Format Colour Finishing and Display Products Scanning / Archiving Document Mgmt
 
How did you hear about Dominion?
Trade References
Trade Name:
Address:
Phone:
Fax:
How long dealing with?
   
Trade Name:
Address:
Phone:
Fax:
How long dealing with?
   
Trade Name:
Address:
Phone:
Fax:
How long dealing with?
Financial Information
Bank Reference
Name:
Branch:
 
Purchase Order Required? Yes  No
Tax Numbers
HST:
 
By submitting this form, I/We make application for open terms and certify that the information given for the purpose of opening this account is true. I/We authorize verification of the above facts. I/We accept the Vendor's privilege to charge interest on all overdue accounts.