APPLICATION FOR ACCOUNT

APPLICATION FOR ACCOUNT - PARTS OR SERVICE
Contact Information

1. Name / Trade Name
2. Address
3. City
4. State/Prov
5. Zip/Postal Code
6. Phone
7. Fax
8. Contact
9. Name of Principles
10. Title
11. Name of Principles
12. Title
13. IRS# / SS# (US only)
14. Numbers of Years in Business
15. Truck #'s
16. Type of Firm:
    Partnership
    Proprietorship
    Corporation
17. Anticipated Monthly Purchases: $
18. P.S.T. Exempt # (Canada Only)

BANKING INFORMATION

20. Bank Name
21. Contact
22. Address
23. Account Number
24. Phone Number / Area Code

TRADE REFERENCES

25. 1 Company Name
26. Contact / Phone Number
27. Address
28. 2 Company Name
29. Contact / Phone Number
30. Address
31. 3 Company Name
32. Contact / Phone Number
33. Address
34. If credit is extended to you, who is authorized to charge on your behalf?

AUTHORIZATION AND DATE CONSENT:

I (we) hereby authorize Hammond Air Conditioning Ltd. to obtain credit or other information as may be deemed necessary in connection with the establishment and maintenance of a credit account or for any other direct business required.

I (we) ( Company Name ) understand that accounts in arrears are subject to a service charge at a rate of 2% per month on outstanding balances in excess of 30 days. Accounts not paid within 30 days are considered past due and may cause interruption in credit extended. I further agree to pay collection and / or legal fees incurred by Hammond Air Conditioning Ltd.. in collection of any past due amounts

1. Application Date
2. Signed By:
3. Print your name here:
4. Your Email Address

To fax application, print and fax to 1-888-267-3745

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