I/We for the purpose of obtaining credit from you, do make the following representations:

Customer Name:
Phone No:

Mailing Address:

City: Prov:
Postal:

Shipping Address:

City: Prov:
Postal:

Sole Proprietorship Partnership Limited Company

Legal Name of Business (if different from above):

Nature of Business:
Years:

Purchase Orders Required: Yes No

Account Contact Person:
Fax No:

Comptroller:
Purchasing Agent:

E-mail Address:
Web Page Address:

P.S.T. Exemption Certificate No:
G.S.T. No:

Name and Address of Principals:

Name Title
Address

Name Title
Address

Bank-Branch Address and Account Number

1.

Three Trade/Supplier References (Full names, phone/fax numbers)

1.

2.

3.

Anticipated Monthly Credit Required: $

ACCOUNT AGREEMENT
In consideration of Moore Industrial Ltd. Granting credit to the undersigned customer, the undersigned customer covenants and agrees to be bound by the following terms and conditions governing all such credit purchases, namely:
1. Payment in full for all purchases shall be made on or before the 30th day of the month following.
2. In addition to the purchase price, the undersigned customer agrees to pay a service charge of 2% per month (24% per annum) compounded annually on overdue accounts.
3. Goods returned in saleable condition and approved for return by Moore Industrial Ltd. are assessed a restocking charge of 20% of the sale price of the goods.
4. Moore Industrial Ltd. reserves the right to cancel credit privileges at any time.
5. The undersigned customer consents to the obtaining of such information as Moore Industrial may require at any time, in connection with the credit hereby applied for or any renewal or extension thereof and to the disclosure of any information concerning the undersigned customer to any credit reporting agency or to any person with whom the undersigned customer has or proposes to have financial relations.
The undersigned customer acknowledges that it has read and fully understands this agreement and the terms of payment and that there are no other agreements regarding this account other than those herein contained. The undersigned customer affirms that the information contained in the application portion of this document is true and correct.

DATE:
CUSTOMER’S SIGNATURE:

Title (if customer is a limited company):

OFFICE USE ONLY

Date: Account #: Sales Territory: