Credit Application

Company Name*

Name (of president, sole proprietor and/or partner – note that the person completing the application must have signing authority on the company bank account)*

Date*

Company Address*

Street Address City Province Postal Code

How long has your company been at the above address?*

How long has your company been in business?*

Email Address For Invoicing*

Company Phone Number*

Where did you hear about us?*

If "other", please specify

Business Industry*

Business Type*

Name of shipper*

Email*

Phone number for shipper*

Extension number for shipper (if applicable)

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Name of Bank*

Branch Address*

Street Address City Province Postal Code

Bank Institution #*

Bank Transit #*

Bank Account #*

Branch account manager name*

Branch Account Manager Phone*

Branch Account Manager Email*

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Reference 1

Reference 1: Name/Company*

Reference 1: Phone*

Reference 1: Email*

Reference 2

Reference 2: Name/Company*

Reference 2: Phone*

Reference 2: Email*

Reference 3

Reference 3: Name/Company*

Reference 3: Phone*

Reference 3: Email*

Amount of credit requested*

Payment terms are net 15 days*

(MINIMUM INVOICE $25.00) Due to the cost of extending credit terms, processing invoices and collections, our minimum invoice amount is $25. You can pay for your deliveries at the time of shipment with Paypal, Credit Card, Debit Card or E-Transfer if you will be using our services for less than the minimum

I understand the minimum invoice disclosure*

(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

By providing the electronic signature, you are hereby authorizing AAA Express Parcels Inc. to obtain bank and trade references through AAA Express Parcel Inc.’s credit rating process. All information obtained will be held in the strictest of confidence.*

I agree

Note that in order for the credit application to be processed, the person signing the application must have signing authority with the company’s financial institution.*

I understand

Signature*

Name*

Date of Signature*

Title (within company)*

Email address*

Word Verification

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