The Horse Race Game :: The Wildest Way to Entertain

INSTRUCTIONS
1. Please fill in all the necessary information and answer all questions, including how much open account credit you desire.

2. Read our terms of sale carefully, please be aware that you agree to these terms by filling out and submitting this form.

3. When you are satisfied with the information you have entered simply click the submit button at the bottom of the page.

This is a secure form, all data will be PGP encrypted.

You may also download and print this PDF (Portable document format) Application and fax (519.739.3298) or mail it to us. You may need to download Adobe Acrobat Reader (free) to view this file.

BUSINESS INFORMATION (required)
BUSINESS NAME:			Corporation Partnership Sole Proprietorship
Business Address:
City:	State:		Zip:
Phone:	fax:
Names of Officers or Owners of Firm:
Type of Business:		Country of Incorporation:
How Long in Business:	Credit Limit Desired:
EIN or GST/HST #:	TAX or PST #:

Company/Address

Phone

Fax

Name/Address/Branch

Phone

Contact:

Checking Acct #

Savings Acct. #

PURCHASE ORDERS REQUIRED? yes no Will you honor invoices for work produced on order of any of your employees? yes no If NO, name(s) of person(s) authorized to charge:
Name	Position	Phone #



Person Responsible for Payment:

AGREEMENT
By filling out and submitting this application , the authorized officer (a) requests that an account be opened in the name of the company (b)agrees that all purchases are payable within 30 days from date of invoice (c) authorizes the receipt and exchange of credit information (d) agrees to personally guarantee all charges to the account, and (e) agrees to be bound by the terms and conditions (below) and/or as specified under a separate Agreement.

TERMS
Our terms are Net 30 days from date of invoice. No statement will be sent unless requested. A $20.00 fee will be assessed for all checks returned for insufficient funds (NSF). A service fee of 2% per month will be assessed on all balances 31 days an over.

This application MUST be filled out by an officer, partner or proprietor of the firm to authorize opening of the account.

Authorized Name

Your email

Title

Date