Credit Application – City Mix Inc.

Type of application:

Name *

Business name: *

Phone *

Fax *

Email *

Address: *

Please include Street, City/Town, Postal Code

Type of Business/Operating name: *

Legal Structure *

Years in Business

Principal: Legal Name, Address, Phone: *

Principal: Legal Name, Address, Phone *

1. Trade References: Name of business, address, contact person, phone number: *

Premises Owned: *

Name/Address of landlord if rented property:

Legal description of address: *

Accounts Payable Contact:

PST Exempt #

Banking Institution: *

Branch: *

How long: *

Contact: *

Phone: *

Date *

Signature

Typing authorized name constitutes a legal signature by applicant

Name

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