Credit Application

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Company Name*

Company Address*

Street Address City Province Postal Code

Company Contact*

Company Phone #*

Business Industry*

How long has your company been in business?*

Amount of credit requested*

ACCOUNTS PAYABLE

Name of AP Contact*

Phone # of AP Contact*

Email of AP Contact*

SHIPPING DEPARTMENT

Name of Shipping Contact*

Phone # of Shipping Contact*

Email of Shipping Contact*

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Name of Bank*

Bank Account #*

Branch Address*

Street Address City Province Postal Code

Branch account manager name*

Branch Account Manager Phone*

Branch Account Manager Email*

REFERENCES

Reference 1: Contact Name*

Reference 1: Company Name*

Reference 1: Email*

Reference 1: Phone

Reference 2: Contact Name*

Reference 2: Company Name*

Reference 2: Email*

Reference 2: Phone

Reference 3: Contact Name*

Reference 3: Company Name*

Reference 3: Email*

Reference 3: Phone

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By providing the electronic signature, you are hereby authorizing AAA Express to contact your trade references as a part of our approval process. In addition, you acknowledge that our payment terms are Net 15 days, and that you have reviewed and acknowledge our Terms & Conditions (https://aaaexpressonline.com/terms-and-conditions/). All information obtained will be held in the strictest of confidence*

I agree

(Electronic Signature) By selecting the "Submit" button after signing, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement *

PC: Use mouse to sign in the box
Device: Use stylist pen or finger to sign in box

Signature*

Name*

Date of Signature*

Title (within company)*

Email address*

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Credit Application

Click here for PDF version

Company Details

Company Banking Information

Trade References

Company Details

Company Banking Information

Trade References

REFERENCES