To apply for credit with Master Flo Valve Inc., please provide the information requested below.
This Master Flo credit application is for a project in the following region:
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Are you a Master Flo customer or an agent/sales representative?
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1. Company Details
Full Legal Business Name
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If you do not have a credit information document, complete the questions below.
Business Address
City
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Province/State
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Postal Code/Zip Code
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Country
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Telephone Number
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Fax Number
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Email Address
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Website Address
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Form of Business
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Type of Business
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Years in Business
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Dun & Bradstreet Number
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Federal Tax ID/Federal Sales G.S.T. Number
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Provincial/State Sales Tax Number
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Country in Which Product is Required
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Indicate % withheld if you answered Yes above
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Preferred Currency for Purchases
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Requested Credit Limit
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Expected Monthly Purchases (in currency selected above)
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2. Company Accounts Payable Information
Contact Name
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Contact Email
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Contact Telephone Number
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Company References
The references should be industry related with equivalent transactions. You have the option to attach Credit Reference Information at time of submission.
Reference #1
Company Name
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City
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Transaction Value
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Telephone Number
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Fax Number
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Reference #2
Company Name
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City
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Transaction Value
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Telephone Number
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Fax Number
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Reference #3
Company Name
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City
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Transaction Value
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Telephone Number
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Fax Number
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3. Bank Reference
Bank Name
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Address
City
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Province/State
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Postal Code/Zip Code
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Country
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Contact Name
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Telephone Number
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Email Address
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4. Invoicing Preferences
How Would You Like Your Invoices Submitted?
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Name of Electronic Submission System
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Email Address to Submit Invoices
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Mailing Address
City
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Province/State
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Country
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5. Invoicing Requirements
To be supplied with invoices.
What Information Must Invoices Include?
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Currency to be Invoiced
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6. Names of Key Executive Officers & Directors
Please List Your Executive Officers & Directors
Full names are required
Name {binding ItemNumber}
Name
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Title
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Telephone Number
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City
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DISCLAIMER
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The above information is warranted to be true and is given for the purpose of obtaining credit. In the event credit is granted, I/we agree to abide by your terms of sale-net 30 days. I/we agree to pay interest charges at the rate of 18% per annum on overdue accounts.
Disclaimer Acceptance
Completed By
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Title
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Telephone Number
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Email Address
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Date
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