Apply for Account

Use this form to submit information on your company to assist in establishing an open account at Plitron Manufacturing.

Company Information

Your Name
Company (Required)
Division
Address (Required)
Address 2
City
State / Prov.
ZIP / Postal Code
Country
Telephone
FAX
Web Site
EMail
President/CEO
Purchasing Contact
Accounting Contact
# of Employees
Annual sales
D & B Rating
Year Established (Required)
Federal Tax Id Number (EIN)
Credit Requested
Attach File

Bank

Name
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
Contact
e-mail
Credit Limit

Reference 2

Company
Address
Address 2
City
State / Prov.
ZIP / Postal Code
Telephone
Contact
e-mail
Credit Limit

Reference 3

Company
Address
Address 2
City
State / Prov.
ZIP / Postal Code
Telephone
Contact
e-mail
Credit Limit

Any questions regarding this form can be addressed to Plitron HR Administrator Christine Belso 416-667-9914 extension 222.

See Bottom of Page for Transmission Messages Related to This Application.


By selecting the Accept Button I 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. I am hereby authorizing Plitron Manufacturing Inc. or its agents to obtain to make inquiries into the banking and business/trade references that I have supplied. I understand that Plitron Manufacturing Inc. Terms and Conditions of Sale apply to any purchase orders place with Plitron Manufacturing Inc.