Account Setup Form and Credit Application

Name/Address

First Name^*

Last Name

Middle Initial

Email^*

Phone Number^*

Name of Business^*

Tax I.D. Number^*

Address^*

City^*

Province/State^*

Postal/ZIP Code^*

Company Information

Type of Business^*

In Business Since^*

Legal Form of Business^*

If Division/Subsidiary, Name of Parent Company

In Business Since

Name of Company Principal Responsible for Business Transactions^*

Title/Position^*

Address^*

City^*

Province/State^*

Postal/ZIP Code^*

Phone Number^*

Trade References

Reference 1

Company Name

Contact Name

Credit Limit

Account opened since

Address

City

Province/State

Postal/ZIP Code

Phone Number

Reference 2

Company Name

Contact Name

Credit Limit

Account opened since

Address

City

Province/State

Postal/ZIP Code

Phone Number

Reference 3

Company Name

Contact Name

Credit Limit

Account opened since

Address

City

Province/State

Postal/ZIP Code

Phone Number

Line of Credit

Would you like to apply for a line of credit^*

YesNo

Credit Term

Credit Amount

I, on behalf my company, will make full payment before the due date to HYC Design Inc. We understand if my account is outstanding (not paid in full within 30 days) , there will be a $60 admin fee, plus 3% interest charge per month for any outstanding amounts over-due. HYC Design has the right to report my account to credit reporting agencies and take legal action. I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for to verify the information contained herein.

Print Name

Position

E-signature

Date

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Account Setup Form and Credit Application

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