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Canadian Channel Partner Credit Application

"*" indicates required fields

Mailing Address*
Shipping Address*
Business Type*
Are you tax exempt?*
Max. file size: 64 MB.

Accounting, Shipping, and Sales Contacts

Name of Officer(s):

Please provide the name(s) of all officer(s) in your company
#1: Name*
Address*
#2: Name
Address
#3: Name
Address

Trade References

#1: Name*
Address
#2: Name*
Address*
#3: Name*
Address*

Bank Information

Contact Name*
Address*

General Information

Please indicate which of the following market segments your company serves:*

Authorization

Permission is herewith granted to obtain credit information from all listed references including my bank. All financial Information submitted in support of this credit application is accurate and complete in all respects. A service charge of 2% per month (24% annually) will be levied on all past-due amounts. Furthermore, I understand that my orders may not be shipped if my account is past-due and that all collection fees (including legal fees), and related costs are my responsibility in the event of non-payment. I/We hereby authorize Talius to obtain personal and credit information about us and/or our company from any source. By my/our signature(s) below I/We acknowledge in this notice of writing, Talius’ intent to obtain this information. I/We make this application on behalf of the above mentioned company and understand that the information contained within is for the explicit use of Talius. I/We have the ability to bind the Company.
Name*
Max. file size: 64 MB.
Name
Max. file size: 64 MB.
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