Palans et Outillages Léger inc.
7995 17e avenue
Montreal, Quebec Canada
H1Z 3R2		 Telephone : 514-376-3050
Fax : 514-376-0657
 
Please print and fax this request to open an account at: 514-376-0657, your signature is obligatory.
 
Credit Application
 
Company name: _________________________________________
Address:                        _________________________________________
City:                          _________________________________________
Province:                       _________________________________________
Country:                        _________________________________________
Postal or Zip code:              _________________________________________
Telephone:                       _________________________________________
Fax: _________________________________________
eMail: _________________________________________
Number of years in business: _________________________________________
Name of owner (s): _________________________________________
Address of owner (s): _________________________________________
 
Bank Reference
 
Bank name: _________________________________________
Address: _________________________________________
Telephone: _________________________________________
Fax: _________________________________________
Account number: _________________________________________
 
Credit References
 
1.
Name: _________________________________________
  City: _________________________________________
  Telephone: _________________________________________
  Fax: _________________________________________
     
2.
Name: _________________________________________
  City: _________________________________________
  Telephone: _________________________________________
  Fax: _________________________________________
     
3.
Name: _________________________________________
  City: _________________________________________
  Telephone: _________________________________________
  Fax: _________________________________________
   
We declare the above information to be true, and we authorize our financial institution and suppliers to disclose information to Palans et Outillages Léger inc. for verification purposes.
   
Authorized signature (required):_____________________________________
Date:________________