Credit Application

You may fill out the form below.
One of our representatives will get in touch with you.

DATE:

Company Name:

Billing Address:

Telelphone:

Fax:

eMail:

*****

Year Established:

Type of Business:

Credit Amount Required:

*****

Name of Bank:

Contact:

Phone:

eMail:

Account Number:

*****

Three credit references, other than transportation companies:

Ref 1:

Phone:

Ref 2:

Phone:

Ref 3:

Phone:

GST EXEMPT :

Yes
No

*****

ACKNOWLEDGEMENT: Please read carefully and initial below

It is agreed and understood by the applicant that payment shall be made within
30 days of invoice date of all assessed charges rendered by Load Solutions Inc.

An interest rate of 2% per month may be calculated on all outstanding balances.
Failure to comply with payment instructions may be sufficient for Load Solutions Inc.
to suspend credit privileges.

I / We hereby agree to the above stated terms and conditions and permit Load Solutions Inc.
to conduct or cause to conduct an investigation regards to this application indicated by
the signature below.

*****

Accepted by:

Print Name:	*
Title:	*
Signature Date:		October 23, 2011, 10:20 am
Initials:	*

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