Download & Print the Credit Application Form ... - Wolseley Express

WOLSELEY CANADA INC.3780 – 98 th Street Edmonton, Alberta T6E 6B4Phone: 780-577-1021 Fax 780-469-6407 (Revised 01-07-13)B.C. Mechanical Division ______ B.C. Waterworks Division _______ Cronkhite Supply B.C. _______( Please indicate in which Division you are requesting to have a Credit Account )CREDIT APPLICATION – Page 1 of 3Please fax application to (780) 469-6407 when completePLEASE RETURN APPLICATION TO CREDIT DEPARTMENTFAILURE TO COMPLETE ALL SECTIONS WILL DELAY THE PROCESSING OF THIS APPLICATIONYour signature is required on back or Page 2 if faxed.A) BUSINESS PROFILECorporation Partnership Proprietorship Co-operative Society Other SinceTrade Name Business Type FaxLegal Name (herein referred to as the Applicant) Telephone CellBilling Address City Province Postal CodeShipping Address City Province Postal CodePurchasing Agent E-Mail H.S.T. #Payable AgentE-MailB) GIVE FULL NAME AND HOME ADDRESS OF OWNERS - PARTNERS – OFFICERS OF BUSINESSPrint Name Title Home Address and Phone Number Birth Date or SIN123C) BUSINESS BANK REFERENCES Bank Name Financial Statement: Attached Will FollowBranch – Address in Full Bank Acct. No. Line of Credit Contact Tel FaxD) CREDIT REFERENCES (MAJOR SUPPLIERS)1. Supplier Contact TelephoneAddressFax2. Supplier Contact TelephoneAddressFax3. Supplier Contact TelephoneAddressFaxE) GENERAL INFORMATIONCredit Line RequestedEst. Monthly PurchasesAccept Back OrdersPurchase Order #’s on InvoicesName of Person Picking Up$Job Name$Priced Packing SlipsYESNOMonthly Statement ReqYESNOContractor’s License No.YESNOYESNOYESNOYESNO

Page 2 of 4G) ADDITIONAL COMMENTS:This agreement is made between the Applicant and Wolseley Canada Inc., (hereinafter referred to as “Wolseley”) and their successors andassigns, it being understood that Wolseley Canada Inc. carries on business under various trade names.The Applicant agrees that all invoices will be paid in accordance with the terms of sale stated on each invoice. Accounts not paidwithin the agreed to terms shall be deemed “overdue accounts”. Applicant/s further agree that Wolseley reserves the right toincrease, decrease, modify, suspend and or cancel any credit privileges at any time without notice to the applicant.Invoices and Statements of Accounts will be considered correct if no exceptions are reported in writing within 30 days from the date of theinvoice or statement.Interest at a rate of 2% per month compounded monthly or 26.8% per annum may be charged on all overdue balances and this rate will apply toboth pre and post judgment balances. The applicant hereby agrees to pay all such charges arising on this account.All changes in the applicants company’s structure and/or its owners and shareholders will be immediately reported to Wolseley in writing.Should Wolseley secure the services of a lawyer to collect Applicants overdue balance, the Applicant agrees to pay for such legal services on asolicitor and his own client basis.Permission from Wolseley must be obtained before returning goods for credit. Applicant acknowledges that restocking charges may apply.There are no warranties or guarantees applicable to goods except as given in writing by Wolseley or by the supplier/manufacturer.In the event that the Applicant purchases materials pursuant to this Application and supplies or incorporates materials in respect of animprovement pursuant to the provincial Builders’ Lien Act THEN THE APPLICANT ACKNOWLEDGES that the materials have beenpurchased pursuant to a prevenient arrangement and that one continuing contract is deemed to be in place.The Customer agrees that the title to any and all goods supplied by Wolseley shall remain Wolseley property until the Applicant has paid for thegoods in full. Wolseley shall have a continuing purchase money security interest in all such goods and their respective proceeds to secure theperformance by the Applicant of all its obligations to Wolseley. The Applicant waives the right to receive a copy of any financing statement andverification statement and acknowledges receipt of a copy of this Agreement. I/WE also agree to jointly and severally indemnify Wolseley andsee you paid for any purchase made by the corporate customer or any debt owed to Wolseley by the corporate customer pursuant to thisagreement.If two or more persons are liable under this Agreement, their obligation shall be joint and several.The Applicant hereby authorizes Wolseley to conduct, or cause to be conducted, as required, credit investigations on myself (ourselves), my (our)company(ies) and or any related persons or companies. The Applicant hereby authorizes Wolseley to divulge credit references to other creditorsas requested with regards to the credit history of Applicants account pursuant to the terms of Wolseley privacy policy.The Applicant/s hereby states that the information on this Application is true and complete. The Applicant authorizes Wolseley to collect, useand disclose credit and other related information as deemed necessary on an on-going basis, on the Applicant, the Principals of the Applicant, andthe signatories on behalf of the Applicant for purposes of extending and administering credit.Any signed original and/or copy of this document is considered valid and true and holds the signee responsible for all informationprovided on this document.__________________________________________________________Authorized Signature______________________________________________________Printed Name__________________________________________________________Date______________________________________________________City/Town and ProvinceF) INTERNAL INFORMATION – TO BE COMPLETED BY WOLSELEY Customer ClassEstimated Monthly Sales $ Orders on Hand $ Account # SIC CodePotential Annual Sales $ Representative Rep # TerritorySchedule Indentification Price Column Approved By Branch

Page 3 of 4INVOICE/STATEMENT DISTRIBUTION INSTRUCTIONS:We provide electronic distribution of customer documents, via email with access to archiveddocuments through our e-commerce website wolseleyexpress.comPlease provide us with the following information, so as we can register you on wolseleyexpressand set your account to commence document distribution in this manner.Company Name: _______________________________________________________________Title of Registrant: ______________________________________________________________First Name: ___________________________ Last Name: ______________________________Email Address: _________________________________ Phone Number: __________________IN ADDITION TO “MY ACCOUNT” STATUS, I REQUIRE THEFOLLOWING: (PLEASE CHECK OFF)____________________ACCESS TO INVENTORY QUANTITY & PRICE BY BRANCH IN PRODUCT PAGEACCESS TO THE SHOPPING CARTACCESS TO ORDER STATUSACCESS TO MANAGE USERS (NORMALLY FOR OWNER ONLY)Customer Approval____________________________________Name__________________________________________Title___________________________________Authorized Signature__________________________________________Date

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