Name of Business:
Mailing Address:    
City:     Prov:     Postal Code:
   
Phone#:     Fax#:     Accounting Contact:
E-Mail:
   
PU/Delv Address:    
City:     Prov:     Postal Code:
   
Type of Business:     Years in Business:
   
Name of Principals:     Title:
      Title:
   
Trade Reference #1:     Name:     Phone#:
  Address:    
Trade Reference #2:     Name:     Phone#:
  Address:    
Trade Reference #3:     Name:     Phone#:
  Address:    
   
Bank:     Branch:     Phone:
GST Reg#:  (if applicable)
   
Credit Limit Required:         Monthly     OR         Yearly
   
Submitted by:     Title:
   


Conditions of Extension

To ensure continuance of applicable discounts, accounts must be kept current.

By clicking the SUBMIT button, I (we) hereby authorize Van Kam Freightways Ltd., to whom this application is submitted, to obtain such credit reports or other information as may be deemed necessary in connection with the establishment and maintenance of a credit amount or for any other direct business requirements.