Butler Scaffolding Credit Application

Butler Scaffolding Rentals & Sales Ltd.

Credit and Customer Information Form

Full Legal Business Name:

Mailing Address:

City/Town: Province: Postal Code:

Telephone: Fax: Years in business:

Shipping Address if Different from Above

Shipping Address:

City/Town: Province: Postal Code:

Names of Officer(s) and/or Owner(s)

Name: Title:

Banking Reference:

Address:

Telephone: Fax: Contact:

Principal Suppliers (reference)

Accounting Contact: Title:

Telephone: Extension:

The undersigned agrees that usual credit inquiries may be made at any time in connection with credit applied for and consents to the disclosure of such information.

Terms: NET 30 DAYS

Fax: (902) 455-2251

Authorized:

Title:

Date:

Butler Scaffolding Rentals & Sales Ltd. `Credit and Customer Information Form`
Full Legal Business Name:
Mailing Address:


City/Town: Province: Postal Code:
Telephone: Fax: Years in business:
`Shipping Address if Different from Above`
Shipping Address:


City/Town: Province: Postal Code:

`Names of Officer(s) and/or Owner(s)`
Name: Title:

Banking Reference:
Address:


Telephone: Fax: Contact:
`Principal Suppliers (reference)`


Accounting Contact: Title:
Telephone: Extension:
The undersigned agrees that usual credit inquiries may be made at any time in connection with credit applied for and consents to the disclosure of such information.
Terms: NET 30 DAYS *Fax: (902) 455-2251*	Authorized:
	Title:
	Date: