NOTE: You must provide an email and phone number. Also remember to check off the confirmation box at the bottom of the page. Company Profile RR #2 Tottenham Ontario Canada, L0G 1W0 Phone: 1-800-263-1281 / 905-936-3580 Fax: 1-888-225-5535 / 905-936-3585 Business Information Company Name: Phone: Fax: Website: E-mail: Mailing address: Shipping address (if different): Contacts & Description of Business Contacts for: Number of Locations: Sales Updates & Info: Years in Business: Purchasing: Type of Business: Retail Wholesale Institution Payables: Shipping & Receiving: Financial Information Financial Institutions Name & Address: Contact: Account #: Phone: Fax: Applicable Tax Numbers GST/HST: PST: Federal ID#: Trade References Firm Name Contact Account # Fax CONFIRMATION OF INFORMATION ACCURACY AND RELEASE OF AUTHORITY TO VERIFY   I hereby certify that the information in this credit application is correct. The information included in this credit application is for use by Parsons A.D.L. Inc. in determining the amount of credit to be extended. I understand that Parsons A.D.L. Inc. may also utilize such other sources of credit which it considers necessary in making this determination. Further, I hereby authorize the financial institutions and trade references listed in this credit application to release the information necessary to assist Parsons A.D.L. Inc. in establishing a line of credit. NEW ACCOUNTS WILL NOT BE PROCESSED UNLESS ACCOMPANIED BY THE ABOVE REQUESTED INFORMATION. Terms: net 30 days from date of invoice unless otherwise stated.