Application for Credit Account – Mesco Electronics

If you are human, leave this field blank.

Full Company Name: *

Head Office of Parent Co.

Mailing Address: *

Telephone #: *

Fax #:

Name of Prinicipal Officers/Owners: *

Type of Business: *

Name & Address of Bank: *

Bank's Telephone #: *

Bank's Contact Name: *

In Business Since: *

PST Exempt: *

Yes

Please List Three Trade References:

1. Company Name:

1. Company Address:

1. Company City, Province:

1. Comapny Phone #:

1. Company Fax #:

2. Company Name:

2. Company Address:

2. Company City, Province:

2. Comapny Phone #:

2. Company Fax #:

3. Company Name:

3. Company Address:

3. Company City, Province:

3. Comapny Phone #:

3. Company Fax #:

Are You Authorized to Submit A Credit Application?

Yes

Your Name & Title: *