Company Name: Mailing Address: City:
Prov./State: Postal/Zip Code:
Street Address for Shipping Purposes: Phone #:
Facsimile #: Email:
Date Business Started: # of Staff: Premises: Owned or Rented
Is company a?: Corporation Partnership Proprietorship Other:
Principal(s) or Owner(s): Years at present location?:
Type of Business?: List any/all previous business names and/or affiliations:
PST Exempt #: GST #:
Accounts Payable Contact: A/P Phone #: A/P Facsimile #:
Accounts Payable Email: Anticipated Credit Limited: $
Dun & Bradstreet # (if known): Name of Purchaser:
Are PO # Required?
Name of Bank:
Account # (Required if RBC Account.): Bank Address:
Phone #: Facsimile #: Bank Contact Name:
Supplier Name
Supplier City, Province
Supplier Fax Number
I acknowledge that WALLACE CONSTRUCTION SPECIALTIES LTD. may have collected personal information from me, as defined by the Personal Information and Electronics Documents Act or other provincial legislation. I also acknowledge that WALLACE CONSTRUCTION SPECIALTIES LTD'S. Privacy Policy and its Statement is located on its website at www.wallace.sk.ca and is available for downloading for my information.
I consent to the use of this information for the purposes described in WALLACE CONSTRUCTION SPECIALTIES LTD'S. Privacy Policy.
Our credit terms are Net 30 days from date of purchase. If credit is granted, I/we do hereby agree jointly and individually, to pay for all materials supplied. Interest charges of 2% (24% p.a.) applies to all charges beyond our terms of Net 30 days. The purchaser hereby grants as security for credit terms, a Purchase Security Interest in all products and services sold to the Purchaser. IN CONNECTION WITH MY APPLICATION FOR CREDIT, I HEREBY CONSENT THAT WALLACE CONSTRUCTION SPECIALTIES LTD. MAY CONDUCT A CREDIT INQUIRY.
Signature: Date:
Printed Name: Title:
To: 1940 Ontario Avenue, Saskatoon SK S7K 1T6, CANADA
For valuable consideration, I, the undersigned, do hereby guarantee to you the payment of all moneys, which shall at any time hereafter be due to you by: (Company Name)
This guarantee shall be binding upon my heirs, executors, and administrators.
This guarantee is to be a continuing guarantee.
In witness whereof, I the undersigned, have hereunto set my hand
this day of A.D. 20
Guarantor Signature Guarantor Name, Printed
Street Address & City
Signed in the presense of: (Witness portion must be completed)
Witness Signature Guarantor Name, Printed
