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Credit Applciation & Agreement Form

Please complete and submit the below form for credit application. Or, fax us.
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* denotes required field. Credit application will not be sent unless fields completed.

Applicant contact information

*Your name:
*Email address:
*Phone number:
Fax:
*Mailing address:
*Street Address:
*City:
*Province / State:
Applicant tax information
PST exemption number (Canada Only):
Federal Tax I.D. Number (U.S. Only):
Applicant business profile
Years in business:
Do you rent, lease, or own your place of business:
Do you have a line of credit:
Nature of business:
Primary contact:
Primary contact e-mail:
Purchasing contact:
Purchasing contact e-mail:
Payables contact:
Payable contact e-mail:
Principle's name:
Principle's e-mail:
Applicant Banking Reference
*Bank:
Contact:
Contact e-mail:
*Account Number:
*Address:
*City:
*Province / State:
Telephone number:
Fax number:
Applicant Trade Reference 1
*Company name:
*Contact:
*Contact e-mail:
*Address:
*City:
*Province / State:
*Telephone number:
Fax number:
Applicant Trade Reference 2
Company name:
Contact:
Contact e-mail:
Address:
City:
Province / State:
Telephone number:
Fax number:
Applicant Trade Reference 3
Company name:
Contact:
Contact e-mail:
Address:
City:
Province / State:
Telephone number:
Fax number:
Additional Comments:
Terms and conditions:
Terms of sale call for payment in full of all accounts thirty (30) days from date of invoice unless otherwise specified, in writing, by the seller. Title to materials will not pass untill full and final payment is made. Bridgeline Ropes Inc. reserves the right to charge interest on all past due accounts. The customer hereby authorizes Bridgeline Ropes Inc. to conduct all credt investigations necessary for the approval of this application. Failure to comply with these Terms & Conditions may result in the cancellation of credit privileges.
Privacy policy and consent:
I acknowledge that Bridgeline Ropes Inc. may have collected personal information from me, as defined by the Personal Information Protection and Electronics Documents Act or other provincial legislation. I consent to the use of this information for the purposes described by Bridgeline Ropes Inc. Privacy Policy for customers, and acknowledge that this document is available upon request.

By selecting this button you agree to the terms and conditions outlined above.