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 APPLICATION
TO AGROPONIC INDUSTRIES LTD.,
FOR OPEN
ACCOUNT BILLING
The following
information is submitted as a basis to extend the
undersigned an open account for line of credit. This
page is printable to fax or to mail if you wish.
Please type or print. Fill out form completely -
incomplete forms cannot be processed. Send / fax
to:
Agroponic
Industries Ltd.
att: Accounts Dept.
908 Ranchview Cres. NW.
Calgary, Alberta, Canada, T3G 1P9
ph(403)241-8234, fax(403)241-8238, email
agropon@agroponic.com
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 Company
Name / Insitution:
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Contact
Name:
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Type
of Organization:
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Year
Started:
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Street
#/ Street Name / P.O. Box #/ Apt #/ Suite:
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City:
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State/Province:
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Country:
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Zip
Code or Postal Code:
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ph.
Number:
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Fax
Number:
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Name
of Bank / Address / Telephone:
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Type
of Accounts and name the account(s) is
under:
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Reference
# 1 - Give only names for those that you pay on
an open account. Provide company name, contact
name, address, phone number and credit limit (
approx.
)
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Reference
# 2 - Give only names for those that you pay on
an open account. Provide company name, contact
name, address, phone number and credit limit (
approx.
)
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Reference
# 3 - Give only names for those that you pay on
an open account. Provide company name, contact
name, address, phone number and credit limit (
approx.
)
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Reference
# 4 - Give only names for those that you pay on
an open account. Provide company name, contact
name, address, phone number and credit limit (
approx.
)
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Amount
of credit desired monthly:
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Dated:
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Signed by: ______________________________ Title:
_______________________
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