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Customer Purchase Order Application Form

Please use the form below to apply to use a Corporate Purchase Account. Once the form is completed, it will be submitted for approval and references will be checked. This process takes 5 business days. Once approved, you will be able to purchase from the website using the Corporate Purchase Order process.

Fields in bold are required.

1. Company Information

Legal Company Name

Legal Company Name :: As on legal registration and/or incorporation papers

Present legal form

Present legal form :: If company entity is not listed, select Other

If Other, please specify

Invoice Address

Invoice Address :: Where invoices will be sent

Is invoice address different than ship to address?

Yes
No

Ship to Address

Ship to Address :: If invoice address if different than ship to address, please specify

Telephone No.

Fax No.

Website

Nature of business

Nature of business :: What does your company do?

Business Registration Number

Business Registration Number :: Chamber of Commerce and/or Incorporation Number

Tax Identification Number

Tax Identification Number :: EIN, VAT, GST, MwST or other tax identification number

Number of years in business

Number of Employees

Annual yearly sales

Annual yearly sales :: If no exact figure is available, an approximation is also ok.

Estimated yearly purchases

Estimated yearly purchases :: How much woudl you estimate buying from CAPLINQ Corporation on a yearly basis?

Currency Reference

Currency Reference :: CAD, EUR, USD, JPY, RMB, etc.

Authorized Capital

Paid-up Capital

2. Primary Shareholder Information

Number of shareholders

Primary Shareholder Information

Shareholder Name

Contact Number

Email Address

Shareholdings

Shareholdings :: Approximate % of shareholdings

3. Company Contacts

Please list at least a management contact as well as a financial contact.

	Name	E-mail address	Contact No.
Management Contact
Financial Contact
Accounts Payable
Purchaser

4. Bank References

Please list at least one bank reference.

Name of Bank	Account No.	Contact Person	Contact No. or Email

5. Trade References

Please specify at least one trade reference

Name of Company	Contact Person	Contact No. or Email

6. Requested Credit Limit and Payment Terms

Please specify what you are asking for in terms of credit amount and payment terms

Credit Line Requested

Currency of Purchase

Payment Term Requested

If Other, please specify

Shipping Terms Requested

Shipping Terms Requested :: ie. FOB Canada, FOB Netherlands, CIF, DDU

7. Certification and Authorization

To the best of my knowledge the information provided is true and correct

I hereby authorize CAPLINQ Corporation to verify the above credit references and make any inquiry from any credit reporting agencies as deemed necessary.

Completed by:

Completed by: :: Please fill in your complete name

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