Credit application | Transport BMA

Please fill as many of the field as possible in order to reduce the processing time of your request to a minimum. After filling the form, you will receive a pdf file to the e-mail address provided. To complete the process, you will need to print this file, sign it and send it to the e-mail address at the top of the pdf file.

Bill to

Company*

Contact (mobile)

PO Box

Address*

City*

Province*

Postal Code*

Telephone*

Fax

Ship to

Company*

Contact (mobile)

PO Box

Address*

City*

Province*

Postal code*

Telephone*

Fax

General information

E-mail*

How many years at this address*

Business activity*

Management

Owner 1*

Owner Telephone 1*

Owner 2

Owner Telephone 2

Owner 3

Owner Telephone 3

Resource person for Transport*

Resource person telephone*

Account payable*

Account E-mail*

Telephone linked to the account*

Commercial References

Name 1*

Telephone 1*

Fax 1

Name 2*

Telephone 2*

Fax 2

Name 3

Telephone 3

Fax 3

Bank References

Name*

Address*

City*

Province*

Telephone*

Contact*

Account no.*

Maximum credit limit requested ($)*

Payment term (days)*