Messier-Matic Ltd,
3446 St-Denis Street, suite 102
Montreal, Quebec Canada
H2X 3L3 		Tel. (514) 845-6297
Fax (514) 843-1000
info@messiermatic.com
 
Please print and fax this request to open an account to Messier-Matic Ltd at: (514) 843-1000, your signature is obligatory.
 
Credit Application
 
Company name: _________________________________________
Address:                        _________________________________________
City:                          _________________________________________
Province:                       _________________________________________
Country:                        _________________________________________
Postal or Zip code:              _________________________________________
Telephone:                       _________________________________________
Fax: _________________________________________
eMail: _________________________________________
Number of years in business: _________________________________________
Name of owner (s): _________________________________________
Address of owner (s): _________________________________________
 
Bank Reference
 
Bank name: _________________________________________
Address: _________________________________________
Telephone: _________________________________________
Fax: _________________________________________
Account number: _________________________________________
 
Credit References
 
1.
Name: _________________________________________
  City: _________________________________________
  Telephone: _________________________________________
  Fax: _________________________________________
     
2.
Name: _________________________________________
  City: _________________________________________
  Telephone: _________________________________________
  Fax: _________________________________________
     
3.
Name: _________________________________________
  City: _________________________________________
  Telephone: _________________________________________
  Fax: _________________________________________
     
We declare the above information to be true, and we authorize our financial institution and suppliers to disclose information to Messier-Matic Ltd for verification purposes.
     
Authorized signature (required):_____________________________________
Date:________________