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DSA FURNISHINGS
820 Nipissing Road, Unit 1  
Milton, ON  L9T 4Z9 
PH:  905-876-3114
Toll Free:  1-888-876-3114
Fax:  905-876-0657
info@dsafurnishings.ca
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Published Aug. 2003

 

DSA Furnishings

Credit Application

For PDF Version, click here.
Print and Fax to 905-876-0657

The undersigned company is applying for credit with DSA Furnishings, a Division of The Don Smith Agency Inc., and agrees to abide by the standard terms and conditions of DSA Furnishings, as set forth below.

Company Name: DBA (if different):
Contact Person: Telephone:
Address Fax:
  E-mail Address:
City: Prov: PC: PST #: GST #:

Form of Business (check one):

q  Corporation (Province of incorporation:_____) q  Limited Partnership
q  Limited Liability Company q  Individual/Sole Proprietor
q  General Partnership q  Non-Profit Organization
Are you Sales Tax Exempt?    Y      N Have you ever had credit with us before?  Y   N
If yes, state exemption: If yes, under what name?:

 

Name, Title and Address of your Three Chief Corporate Officers, Partners, or Owners.

Name Title Address %
1        
2        
3        
Trade References
Name Address Telephone
1      
2      
3      
Bank References
1 Bank Name: Address: Account No.
  Contact Person: Telephone: Account No.
2 Bank Name: Address: Account No.
  Contact Person: Telephone: Account No.
Declaration:  I represent that the above information is true and is given to induce DSA Furnishings, a division of The Don Smith Agency Inc., to extend credit to the applicant.  My company and I authorize DSA Furnishings to make such credit investigation as DSA Furnishings sees fit, including contacting the above trade references. banks and credit reporting agencies to disclose to DSA Furnishings any and all information concerning the financial and credit history of my company and myself.
I have read the terms and conditions stated below and agree to all those terms and conditions.
Authorized Signature:   Printed Name:  
Title:   Date:  

STANDARD TERMS AND CONDITIONS

  1. DSA Furnishings must be notified in writing of any majority change in ownership at least 15 days prior to such change.
  2. All damaged or mis-shipped goods must be reported to DSA Furnishings within 30 days.
  3. Bills are payable upon receipt unless specifically indicated otherwise.
  4. Interest is payable on past-due obligations at the maximum legal rate, and may include reasonable collection agency and attorney fees, should they be required.
  5. No additional credit will be extended to past-due accounts unless satisfactory arrangements are made with our credit department.

All spaces must be filled in, and a company principal must sign this form before credit will be granted.

 
 

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Copyright © 2004 DSA Furnishings
Last modified: January 12, 2005