Name of establishment:
Address:
Phone Number:
Email:
Ownership
Type:
Proprietorship
Partner
Corporation
Ltd. Co.
Bookstore
Other
Specify:
Name:
Address:
Principal Owners:
Phone Number:
No. of years in business:
Name of Bank:
Branch Address:
City/Province:
Postal Code:
Officer to contact:
Phone Number:
Principal Suppliers
1. Name:
Phone Number:
Address
Postal Code
2. Name:
Phone Number:
Address
Postal Code
3. Name:
Phone Number:
Address
Postal Code
I hereby request that an account be opened with A.G. City Wholesale Ltd. and authorize you to obtain a report containing the credit and personal information you may require. If my application is approved, I agree to be bound to the terms and conditions of the terms of sale.
I agree to be bound to the terms and conditions of the terms of sale.
I disagree to be bound to the terms and conditions of the terms of sale.
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