credit request

You can directly fill out all fields in the following form, print it, sign it and return it to:

By mail: 3735 Jean-Rivard Street, Montreal, Québec, H1Z 4K1

By email: info@olympiatubes.com

By fax: 514 729-2308

If you prefer printing it and filling out manually, please be sure to write clearly. Need help? 514 729-6367

APPLICANT

Last & First Name
Telephone
Address
Fax
City
Province/State
Country
Postal Code
Type of Business
Established since
Anticipated Annual Purchases($)
Resquested Credit Limit

SHIPPING ADDRESS

Same as Applicant

SHIPPING ADDRESS
Telephone
Fax
City
Province/State
Country
Postal Code

SEND INVOICE TO

Last & first name
Telephone
Invoicing Address
Same as Applicant
City
Province/State
Country
Postal Code
Accounts Payable Responsible
Telephone
FAX
email

FINANCIAL INSTITUTION

Name of main Financial Institution
Account Number
Address
Telephone
City
Province/State
Country
Postal Code

REFERENCES name and address of three (3) major suppliers

Last & First Name
Telephone
Fax
ADDRESS
postal code
Last & First Name
Telephone
Fax
ADDRESS
postal code
Last & First Name
Telephone
Fax
ADDRESS
postal code

COMMENTS and/or SPECIAL MENTIONS

(ex: Team needed for unloading, maximum weight, etc.)

CERTIFICATION

The applicant consents to the obtaining of credit information including banking information as may be required with the credit line hereby applied. The undersigned certifies that the information given in the application is to be true and correct.

Applicant's Name
Authorized Signing Officer's Name
Authorized Signing Officer's Title
signature
date