Confidential Credit Application and Agreement
with Cookstown Greens Inc.
6321 9th Line R.R. #3
Thornton, Ontario L0L 2N0
Phone: (705) 458-9077
Fax: (705) 458-1707
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Operating Name Legal Name
Delivery Address: Mailing Address (if different):
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Address Address
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City Province Postal Code City Province Postal Code
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Telephone Fax Telephone Fax
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Accounts Payable Contact Telephone Fax
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Name of Bank Address Telephone Account Number
Owners if a proprietorship or partnership,
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Name Residence Address Telephone
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Name Residence Address Telephone
Directors if a corporation,
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Name Title Telephone
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Name Title Telephone
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Name Title Telephone
Trade References (3):
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Business Contact Address Telephone
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Business Contact Address Telephone
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Business Contact Address Telephone
I hereby certify that the above information on this application is true and correct.
I agree that invoices are to be paid by the 15th of the month following each invoice.
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Name Title Date Signature
