Credit Application

Legal Business Name (Full)*

Business Address*

Postal Code*

City/Province*

Telephone Number*

Fax Number*

Corporation*

Date of Incorporation*

Partnership*

Principal Owner (1)*

Principal Owner (2)*

Accounts Payable Contact*

Billing Preference*

Billing Email Address*

Billing Fax*

Sales Representative*

Credit Limit Required*

Please enter a number greater than or equal to 1.

Bank*

Telephone #*

Address*

Account #*

Contact*

Fax #*

References (Please avoid Utility and Fuel Companies)*

Business	Telephone	Address	Fax	Contact	Email

CREDIT TERMS: Net 20 Days (from Date of Invoice/Delivery)

I/We hereby understand that overdue accounts may be subject to a TWO PERCENT (2%) charge per month becoming an actual part of indebtness, along with any and all costs (including legal and collection fees) incurred by Newterm Logistics Inc in collecting the balance of overdue accounts.

Failure on the part of the Applicant to comply with the Credit Terms will be considered sufficient cause to suspend or cancel credit account without notice.

The Applicant hereby authorizes Newterm Logistics Inc to investigate the references listed above and consents to the obtaining and use of credit information from any and all sources in making a determination of credit worthiness, for the purposes of establishing a credit account.

Full Legal Name of Business*

Full Name*

Title*

Date*

Authorized Signature*

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