Please fill in the following or print this form and fax back to Great Plains Cresting at: (403) 250-5096


Great Plains Cresting Ltd
119, 5655 10th St NE           
                                    FAX: (403) 250-5096
Calgary,  Alberta, Canada                                           TEL: (403) 291-2628 or 1-800-661-8556
T2E 8W7                                                                   EMAIL: info@gpcresting.com

Credit Application The following is an application to open an account with Great Plains Cresting.

Company Name:

Address:

City: Province/State:

Postal Code/Zip code:

Phone Number: Fax:

Year Business Started:

Were you referred by someone? No Yes, by who?

Contact Name:

 

Shipping Address (if different from above):

Billing Address (if different from above):

Billing Method:

Please Choose one: Credit desired credit limit: Credit Card

We require all customers to have a credit card  number on file for at least their first year,
should payment be a problem, we will charge any outstanding balances onto the credit card.

                                        Mastercard               Visa

Credit card number:      Expiry:  

Name on the credit card:  

Shipping preferences: 

....... prepaid / collect ......your account no:
.......prepaid / collect ......your account no:
.........prepaid only

......your account no:

References:

Please provide us with 3 company credit references:

Company Name:

Address:

Phone: fax:

Contact Name:


Company Name:

Address:

Phone: fax:

Contact Name:


Company Name:

Address:

Phone: fax:

Contact Name:

Please fax or email this application back to Great Plains Cresting: 403-250-5096, info@gpcresting.com
 
If you are having trouble viewing or printing the following,  Please call (403) 291-2628 and we will fax or mail a copy to you

Thank-you.