B&J Parts Ltd. New Account Application GENERAL INFORMATION Company Name Operating as (DBA) Date Contact Name Street Address City Province Postal Code Phone Toll Free Fax Website Email Address Billing Address (If different) Yes Do you require a PO? □ No □ PST Exempt? How Long have you been in your present business? PST Number How long have you been in your present location? GST Exempt? Are premises Leased □ Owned □ Yes □ No □ Yes □ No □ GST Number $_______________________________ CONTACT INFORMATION Credit Requested Owner's Name Authorized Purchaser Accounts Payable REFERENCE FINANCIAL INSTITUTIONS Name Branch Phone # Name Branch Phone # CREDIT REFERENCE MUST BE FILLED OUT TO OBTAIN CREDIT Name Address Phone # Name Address Phone # Name Address Phone # ACCOUNT FEATURES □ Yes □ Yes Cylink Online Ordering Receive Statements via Email Internal Use Only □ No □ No Sales man code □ Yes □ I-Net Online account information Yes Receive Invoices via Email A B □ No □ No Customer Type TERMS OF PAYMENT: Failure to make payment in full of the balance due within 30 days from the statement date may result in the seller suspending the further manufacture, delivery or shipment of all or any goods until payment is received. A service charge of 2% per month (24% per year) compounded monthly shall be payable on unpaid balance 30 days after date of statement. The undersigned consents to the obtaining of credit or personal information or both as may be required at any time in connection with the credit hereby applied for or or extension or collection thereof and to the disclosure of any information concerning the undersigned to any credit reporting agency or to any person with whom the undersigned has or proposed to have financial relations. I/We certify that the information is true and if this application is accepted, I/We agree to abide by the terms above. We are pleased to offer a new service for sending out statements/invoices via email or fax. If you would like to receive your statement via this method, please forward an email to [email protected] or forward your fax number. Date: Signature: Name & Title: Please return completed application to: B&J Parts Ltd. 2549 Kingsway Ave, Port Coquitlam, BC V3C 1T5 Ph: 604-464-6677 Fx: 604-464-9997 Email [email protected]