G.C. Hudson Supply Limited
224 Hudson Point Road
Brockville, Ontario
K6V 7E3
800-267-8157
613-342-4578 Fax 613-342-4702
Family owned and Operated since1948
New Account Request Form
General information
Company Name
Your Full Name
Address
Town Or City
Postal Code
E-mail
Fax#
Phone
PST Exempt
Yes
No
Are PO# Required
Yes
No
Formans Cell #
Type of business
(please select a category and specify)
General contractor:
Road
Building
Trade contractor, specialized in
:
Manufacturer of
Supplier of
Wholesaler of
Retailer of
Other
Owner or officer
(Company president)
Company president
Since
Vise President
Has the company ever filed for bankruptcy:
Yes
No
Have you ever personally filed for bankruptcy:
Yes
No
Credit references
Supplier
Telephone
Fax
Purch./month
1)
2)
3)
Bank
Tel.
Authorization
Accounts over 30 days are charged 2% per month intrest on the unpaid balance.
The above named applicant agree in a credit investigation and aggrees to all the terms and conditions on G.C. Hudson Supply Ltd. rental contracts and invoices.
Company Name:
Applicant's Signature:
Date
