Credit application

Business contact information

Business name *

Telephone *

Fax

Business email address *

Business address *

City *

Postal code *

Billing

Billing address *

City *

Postal code *

Legal trade name *

Business type *

Reg

Ltd

Inc.

Other

Company president *

Home telephone number *

Accounts payables *

Purchasing agent *

Have you previously operated under another name? Which one?

Credit

Credit limit required *

$

You pay invoice in how many days? *

30

10

15

21

Financial institution information

Name of financial institution *

Account number *

Branch address *

City *

Telephone *

In business with bank since *

Contact person *

Name, address and telephone number of your three (3) main suppliers

Name

Address

Telephone

Name

Address

Telephone

Name

Address

Telephone

Agreement

I authorize Masone Pasta Foods Inc. research my credit and I agree to pay 1,5 % interest per month on all past due accounts

Name *

Title *