Account Credit Application
Print this form, then complete and fax to 506-453-1009 or toll free to 800-561-3448
Company Name:                  
Billing Address:                  
                   
Postal Code: e-mail address:
Shipping Address:                
                   
Office Supply Contact:       Acct.Payable Contact:
Office Furnishing Contact:         Computer Supplies Contact:  
Phone No.         Fax No.
     
Please select one classification which best suits the description of your business  
Commercial    
Professional   Number of years in business__________________________
Educational    
Home Office    
Other   Please specify______________________________________________
   
   
Company Principals  
Name Title Home Address Phone  
1.                  
2.                  
3.                  
   
Bank Information  
Name of Bank:           Acct No.      
Address:                  
                   
Phone No.           Fax No.      
Bank Contact:                  
   
Trade References  
Company Name Address Contact Phone  
1.                  
2.                  
3.                  
   
   
  Account Credit Application - page 2  
   
Do you require a monthly statement of your account?(Y/N)__________  
   
Anticipated credit requirement per month $_______________________  
   
HST License number:________________________________________  
   
Do you use Purchase Orders? (Y/N) ______ If "Y", then do you wish your PO# to appear on all your invoices: (Y/N)_____
   
Preferred method of payment: Credit Card _______ / Cheque _______ / Cash _______  
Electronic transfer _______ / Other _______  
   
Authorized to store and use credit card information: Authorized by:______________________________________
 
   
Are you interested in ordering on-line?______ If so, please provide your email address:_____________________________
   
I am authorized to sign on behalf of this company. I certify that all information on this form is correct and agree to
pay according to the terms of each invoice. In the event of late payment, I agree to pay interest and understand
that credit privileges may be revoked. Also, should the account be placed for collection, we agree to pay any collection
charges that may be incurred by a collection agency or legal firm to settle said account. The undersigned official,
to induce the granting of credit to the above named firm, hereby personally guarantees the company's credit.  
   
   
Date:                
   
Signed:       Name & Title:          
     
Covey Basics have two locations to serve you:  
   
896 Prospect Street  
E3B 2T8  
   
Distribution Center: 250 Alison Blvd., Fredericton, E3C 0A9  
   
Phone: (506) 458-8333  
Fax: (506) 453-1009  
Call Toll-Free: 1-800-442-9707  
Fax Toll-Free: 1-800-561-3448  
  FOR OFFICE USE ONLY    
Assigned Sales Representative:       Code:      
Credit Limit:           Corporate Discount:    
Approved by:           Date:      
Delivery Zone:                  
Covey Basics respects your personal privacy. We appreciate your concern about your personal information, and believe ensuring the security of your personal information is an important part of our job. We strive to protect any personal information you give to Covey Basics (Address, Name, Email Address, etc.). If we ask you to provide us with any personal information, we will tell you the purposes for which we intend to use that information. We will not collect, use, or disclose your personal information without your consent. We collect no personal information about you unless you choose to provide that information to us. We do not use techniques that collect personal information about you without your knowledge. Your personal information is not lent or sold to anyone for any purpose.