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HEAD OFFICE: EASTERN REGION OFFICE: WESTERN REGION OFFICE:
277 Basaltic Road, 3524 boul. Poirier, 708 Chester Road
Concord, ON, L4K 4W8 St-Laurent, QC, H4R 2J5 Delta, BC, V3M 6J1
Tel: 905.761.9752, Toll Free: 1.800.997.9752 Tel: 514.904.0575, Toll Free: 1.855.535.0575 Tel: 604.526.1482, Toll Free: 1.877.773.9993
Fax: 905.761.9754, Toll Free Fax: 1.800.595.9754 Fax: 514.904.0658 Fax: 604.525.1293
E-mail: sales@avron.ca E-mail: avronquebec@avron.ca E-mail: saleswest@avron.ca
CREDIT APPLICATION
CUSTOMER INFORMATION
Customer Registered Name _________________________________________________________________________________________________________________________
Address ___________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________________
City ___________________________________________________________________ Postal Code ___________________________________________________________
Telephone Number ___________________________________________________ Fax Number ___________________________________________________________
Contact Name (1) _____________________________________________________ Contact Title (1) _______________________________________________________
Contact Name (2) _____________________________________________________ Contact Title (2) _______________________________________________________
Contact Name (3) _____________________________________________________ Contact Title (3) _______________________________________________________
Accounts Payable Contact ____________________________________________ Years in Operation _____________________________________________________
Email Address ________________________________________________________ Summer Operation (Y/N) _______________________________________________
BANK INFORMATION
Bank Name ___________________________________________________________ Branch Number and Location __________________________________________
Account Number ______________________________________________________ Bank Contact Name ___________________________________________________
Credit Amount Requested _____________________________________________ Bank Phone Number ___________________________________________________
TRADE INFORMATION
Supplier's Name ______________________________________________________ Phone Number ________________________________________________________
Supplier’s Name ______________________________________________________ Phone Number ________________________________________________________
Supplier’s Name ______________________________________________________ Phone Number ________________________________________________________
Supplier’s Name ______________________________________________________ Phone Number ________________________________________________________
Supplier’s Name ______________________________________________________ Phone Number ________________________________________________________
