Customer Access

Credit Request Form



» Customer Information

Legal Business/Corporate Name *

Mailing Address *

City *

Province / state

ZIP *

Country

Contact *

Telephone No. *

Fax No.

E-Mail Address *



» Billing Information (if different from above)

	Same Information

Legal Business/Corporate Name

Billing Address

City

Province / state

ZIP

Country

Contact

Telephone No.

Fax No.

E-Mail Address



» Description of Business

Nature of Business

Date Incorporated/Organized/Acquired

Type of Entity

CAN Federal Tax ID #

GST #

QST #

HST #

US Federal Tax ID #



» Bank Reference

Name

Full Address

Telephone No.

Fax No.

E-Mail Address

Loan No.

Account No.

Bank Officer



» Trade References

› First reference

Name

Full Address

Telephone No.

Fax No.

E-Mail Address

Account No.

Contact Person



› Second reference

Name

Full Address

Telephone No.

Fax No.

E-Mail Address

Account No.

Contact Person



› Third reference

Name

Full Address

Telephone No.

Fax No.

E-Mail Address

Account No.

Contact Person



» CREDIT AMOUNT

Amount of credit requested:



»Additional Information

Business Terminal *

Sales Contact



AUTHORIZATION

I/We hereby authorize the party/parties to whom this application is made to investigate my/our financial responsibility and credit worthiness. I/We further certify that all statements made in this application are given for the express purpose of obtaining credit from MtlLINK Multimodal Solutions Inc. / Les solutions Multimodales MtlLINK inc. which grants credit in reliance thereon and, further, that they are true and for the purpose of establishing a line of credit for the above mentioned company. Verification may be obtained from any source named in this application or from a recognized reporting agency.

I/We accept the payment terms of MtlLINK Multimodal Solutions Inc. / Les solutions Multimodales MtlLINK inc. *

Please be advised that you may be contacted for the purpose of obtaining additional authorization for the request of banking information.



Name *

Title *

	Date: 11/21/2024