Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Fields marked with a (*) are mandatory Any issues filling out the form? Please get in touch with us at contact@palletpickup.ca. Section A - Contact InformationDateType of BusinessCompany Legal Name *Business NumberAuthorized Contact Name *Authorized Contact Telephone *Company WebsiteIn Business SinceCorporation, Partnership, Proprietorship or OtherTrade NameDivision / Subsidiary, Name of Parent CompanyAuthorized Contact TitleAuthorized Contact Email *Head Office Contact NumberHead Office AddressSection B - Accounts Payable InformationBilling Address *If different from Home Office AddressAccounts Payable Manager NameAccounts Payable Manager Telephone NumberAccounts Payable Manager EmailAccounts Payable Contact Name *Accounts Payable Telephone Number *Accounts Payable Email *Invoice EmailTrade References Reference 1 Company Name *Company AddressCompany FaxContact Name *Company Contact Number *Company Email * Reference 2 Company Name *Company AddressCompany FaxContact Name *Company Contact Number *Company Email * Name Company Number Reference 3 Company Name *Company AddressCompany FaxContact Name *Company Contact Number *Company Email *The undersigned confirms that the above information is true, correct and complete. We authorize the company to contact the listed trade references and disclose the necessary credit history for this application, including any renewals or extensions. This information may be obtained from credit agencies or relevant financial entities. All gathered data is strictly for financial evaluation. Trade references are typically verified within 2-5 business days. Authorized Title & Name *Applicant's Signature * Clear Signature Use your mouse or finger to draw your signature in the box above.Submit
