Courtney's Wholesale Confectionery Limited
600 Third Street
London, Ontario N5V 2C2
Tel: (519)451-7440 Fax: (519)451-9792

New Account Application
 Trade Name:
 Company Address:
 City:  Province:  Postal Code:
 Incorporated Name (if different from Trade Name):
 Telephone #:  Fax #:
 Provincial Sales Tax #:  GST Registration #:
 Type of Business:  Year Started:  Proprietorship, Partnership, Corporation
 Accounting Contact Name:  Phone #:
 Email Address:


 Name of Principal (Owner):  SIN #:
 Home Address:  Phone #:
 City:  Province:  Postal Code:
 How long have you owned this business?:  Previous Business:


 Bank Name:  Branch Address:
 City:  Account #:  Contact Name:

 Principal Supplier  Address:  City:  Telephone #:
 1.
 2.
 3.


  I/We the undersigned are making application for an account with Courtney Wholesale Confectionery Limited ("Courtney's"). The undersigned agree(s) to be bound by the terms of sale which are described on the invoice. I/We the undersigned further accept and agree that interest shall be charged, at the rate of 1½ % per month (18% per annum), on all amounts owed which are more than 30 days past due; further, a service charge of not less than $20.00 shall be assessed against each and every cheque that is returned NSF from our bank. I/We the undersigned accept and agree that title to all goods delivered or otherwise provided under this agreement, shall remain with Courtney's, until such time as said goods have been paid for in full, to the satisfaction of Courtney's. The undersigned hereby authorize(s) Courtney's to make inquiries, obtain credit and other information, and to use credit reporting agencies in its consideration of this application. The undersigned further authorize(s) Courtney's to share information with credit reporting agencies, as Courtney's deems appropriate.
 Signature:  Title:  Date:
 Signature:  Title:  Date:

SALES REP USE ONLY OFFICE USE ONLY
Delivery Day: Date:
Sales Day: Customer #:
CT: Signature:
Sales Rep #: Route #:
TR: TG: