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Use this form to e-mail information on your company to assist in establishing an open account.

Submit a payment by credit card.


Company
Legal Business Name
Division
Address
Address 2
City
State / Prov.
ZIP / Postal Code
Country
Telephone
FAX
Web Site
President/CEO
Purchasing Contact
Accounting Contact
# of Employees
Annual sales
D & B Rating
Credit Requested
Bank
Financial Institution
Address
Address 2
City
State / Prov.
ZIP / Postal Code
Telephone
FAX
Contact
e-mail
Line of Credit
Trade References
Reference 1
Company
Address
Address 2
City
State / Prov.
ZIP / Postal Code
Telephone
FAX
Contact
e-mail
Credit Limit
Reference 2
Company
Address
Address 2
City
State / Prov.
ZIP / Postal Code
Telephone
FAX
Contact
e-mail
Credit Limit
Reference 3
Company
Address
Address 2
City
State / Prov.
ZIP / Postal Code
Telephone
FAX
Contact
e-mail
Credit Limit
Notes
 

By selecting the Submit button you agree that the information and statements in this application are true and correct and are made for the purpose of establishing a credit account with Plitron.  You are hereby authorized to obtain any information you consider necessary from any source concerning the statements in this application.  I understand that Plitron Manufacturing Inc. Terms and conditions of Sale apply to any purchase orders place with Plitron Manufacturing Inc.

Duly Authorized Company Representative:  

Regards

Christine Belso

Human Resources & Administration Manager                                                             Plitron Manufacturing Inc.,                                                                    Phone:  416-667-9914 extension 222                                                                       e-mail: cbprivate@plitron.com                                                                               Web:  www.plitron.com

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