Credit Application Form | OZ Optics Ltd.

Credit Application

To process your request as quickly as possible, please ensure that the fields marked in red * are completed before submitting your request. If this data is not entered we will be unable to process to your request.

General Information
Legal Name of Business:*
Trade Name (if any):
Principal Owner's Name:	Dun & Bradstreet #:
Date Established:	Date of Incorporation:
Is the company a subsidiary or division of another company?		YES, NO
Please provide details:
Bill to Address:*
City:*	Province/State:*
Postal/Zip Code:*	Country:*
A/P E-mail:*	A/P Contact:
A/P Tel. & Ext.:*	Fax #:
Web Site Address:	Contact email for this credit application:*

Bank Information
Bank Branch:	Contact:	Tel. #:
Bank Address:	E-mail:	Fax #:

Credit References Information PLEASE LIST (3) MAJOR CREDIT REFERENCES WHERE CREDIT IS CURRENTLY EXTENDED:
Credit Limit Required $:
1) Name:	Contact:	Tel. #:
Address:	E-mail:	Fax #:
2) Name:	Contact:	Tel. #:
Address:	E-mail:	Fax #:
3) Name:	Contact:	Tel. #:
Address:	E-mail:	Fax #:

The above stated firm applies for credit for the supply of goods, services, and materials in accordance with OZ Optics' Standard Terms and Conditions and this application for credit concurrently made. I/We being principal(s) of the corporate customer acknowledge that I/We am/are co-customer(s) / co-purchaser(s) and will be personally responsible jointly and severally with the corporate customer for any and all debts incurred as a result of this application, whether or not the invoice or work order is made out solely in the name of the corporate customer. I/We will jointly and severally indemnify you, and see you paid for your account with respect to any order now or hereafter made by the corporate customer. I/We understand and consent to you obtaining a consumer report containing personal and/or credit information with this transaction. I/We understand and agree that our normal Terms of Payment are Net 30 days subject to credit approval which may be changed at any time at our discretion. Delivery may be interrupted or cancelled if invoices are delinquent.

Once you click submit, you agree to the conditions stated above.

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