Credit Application

CREDIT APPLICATION

* Indicates required field

Date: *

Company Name *

Address *

City *

Postal Code *

Email *

Office No. *

Cellular No. *

Management (or Owner):

Name *

First

Last

Position *

Name *

First

Last

Position *

Bank Reference:

Name of Bank *

Location *

Account Manager *

Tel Number *

Trade Credit References: please supply 3

Company Name *

Credit Dept. Tel No. *

Credit Dept. Email *

Company Name *

Credit Dept. Tel No. *

Credit Dept. Email *

Company Name *

Credit Dept. Tel No. *

Credit Dept. Email *

Amount of credit requested: $ *

TERMS OF AGREEMENT: All invoices are due and payable within 30 days. A service charge of 2% per month will be charged on all accounts over 30 days old. THE APPLICANT PERSONALLY GUARANTEES ALL PAYMENTS DUE ON THIS ACCOUNT. ANY MATERIALS SUPPLIED BY DELLA TERRA – SOIL MANAGEMENT SOLUTIONS LTD. WILL REMAIN THE PROPERTY OF DELLA TERRA – SOIL MANAGEMENT SOLUTIONS LTD. OR IT’S SUBSIDIARY COMPANIES UNTIL THE ACCOUNT IS PAID IN FULL.

*By entering your name as Signature of Principal or Person Authorized to sign for this company on this form it will act as signature acceptance.

Name/Signature Authorizing for Company *

I am authorized to sign for this company *

Yes

Submit

If you would prefer, you can fill and sign credit application, print and send to us, click button below.

credit application form

Della Terra – Soil Management Solutions Ltd. l Mailing address: PO Box 31653, Pitt Meadows BC V3Y 2H1
Phone 604-528-3991 l Email – zena@dellaterrasolutions.com