This Master Flo credit application is for a project in the following region: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Are you a Master Flo customer or an agent/sales representative? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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1. Company Details
Full Legal Business Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Upload Credit Information Document {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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If you do not have a credit information document, complete the questions below.
Business Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Province/State {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Postal Code/Zip Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Fax Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Website Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Type of Business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Years in Business {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Dun & Bradstreet Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Federal Tax ID/Federal Sales G.S.T. Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Provincial/State Sales Tax Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Country in Which Product is Required {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Attach tax certificate if you answered Yes above {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Requested Credit Limit {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Expected Monthly Purchases (in currency selected above) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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2. Company Accounts Payable Information
Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Contact Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Contact Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company References
Upload company references {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Transaction Value {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Fax Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Transaction Value {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Fax Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Company Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Transaction Value {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Fax Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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3. Bank Reference
Bank Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Province/State {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Postal Code/Zip Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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4. Invoicing Preferences
Upload Invoicing Preferences Document {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Name of Electronic Submission System {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email Address to Submit Invoices {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Mailing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Province/State {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Country {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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5. Invoicing Requirements
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6. Names of Key Executive Officers & Directors
Executive Officer & Director Information Document {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Please List Your Executive Officers & Directors
Name {binding ItemNumber}
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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7. Financial Status
If you will be proving, please attach your most recent financial statements {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Main bank name and address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Auditor company name and address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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List your top THREE major creditors {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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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.
Completed By {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Telephone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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