New Customer Account
Credit Information

If you prefer to Print, scan / fax in your Account information, please download the printable version here.

 

If you selected 'Other' from the list above, please specify below:
Contact Information
Business Phone Number *
Business Phone Number
Business Fax Number
Business Fax Number
Mailing Address *
Mailing Address
Shipping Address
Shipping Address
If different from Mailing Address
http://
Payment Information
Note: All accounts are required to provide credit card information, which is kept in a confidential, secure file. If paying by cheque or direct deposit, a credit card number is still required and will be used to process payment if cheque is not received upon delivery.
*No spaces
Billing Address
Billing Address
Accounts Payable Contact
Phone Number
Phone Number
Agreed to and Signed
Date *
Date

TERMS OF AGREEMENT & PAYMENT:

  1. The Doc 60 accompanying your delivery is the invoice and all invoices are due upon delivery. Accounts not paid to terms will be deemed ‘overdue’ and subject to interest at the rate of 2% per month (24% per annum) on any outstanding balance based on the original date of invoice.

  2. By completing this form you authorize the Producer, to use the following Credit Card for purchases of product. You also agree to advise Sara Park immediately upon any change to your credit card status or the details given to us on file, such as expiry date or change of card.

  3. Should legal services be necessary to collect an ‘overdue’ account balance the applicant agrees to pay for such services.