Credit Application

A. Applicant

Legal Name

Street Address

City

Province/State

Postal/Zip

Mailing Address

City

Province/State

Postal/Zip

Phone

Fax

Shipping Address

City

Province/State

Postal/Zip

Type of Business (Public/Private/LTD Partnership/Sub-Chapter, etc.)

Estimated Annual Purchase from The Caulking Store

Financial Contact

Phone

Accounts Payable Contact

Phone

Amount of Credit Requested

Terms Requested

How Long in Business

Banking Information

Bank

Address

City

Province/State

Postal/Zip

Branch Manager Name

Phone

E-mail

Account No.

Type of Account

Tax Information

GST/HST Drop Shipment Certificate

Yes No

Attach Certificate

QST Drop Shipment Certificate

Yes No

Attach Certificate

Sales Tax Exemption Certificate

Yes No

Attach Certificate

(Please circle: British Columbia, Manitoba, Saskatchewan)

Required: Customer is responsible for sales taxes unless applicable Certificates are received.

VAT (if applicable)

Other Tax Identification

I hereby authorize bank named above to release information requested for the purpose of obtaining and/ or reviewing credit.

Trade References

Reference #1

Name

Contact

Address

Phone

Reference #2

Name

Contact

Address

Phone

Reference #3

Name

Contact

Address

Phone

Reference #4

Name

Contact

Address

Phone

The preceding information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize The Caulking Store (TCS) to investigate all references and customary credit information sources including consumer credit reporting repositories regarding my/our credit and financial responsibility for the purpose of obtaining credit and for periodic review for the purpose of maintaining the credit relationship.

Terms

Terms of Sale including payment terms, are TCS Standard Terms and Conditions of Sale. TCS may notwithstanding of inconsistent item in any order or contract place credit restrictions, including holding shipments and/or canceling orders on past due accounts.

Payment Location

All amounts due for purchases from TCS are payable at

It is further agreed that this agreement is entered into in the Province/State of

The agreement is governed by the laws of the Province/State of

Change of Ownership

I/We understand that we must notify TCS in writing and by registered/certified mail of any change in ownership, the name of the business or structure of the business under which credit is established.

In the event of default, and if this account is turned over to an agency and/or an attorney for collection, the undersigned agrees to pay all reasonable attorney fees, and/or costs of collection whether or not suit is filed.

APPLICANT’S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY IN ACCORDANCE WITH ABOVE TERMS. THE APPLICANT ACKNOWLEDGES AUTHORITY TO SIGN ON BEHALF OF THE FIRM.

Firm Name

Name

Title