Message Architects: Credit Application Request Form

Credit Application Request

Complete the form below to begin the application process through Messaging Architects. Print and Fax the application to us at (514)392-1427 or send it electronically by clicking Submit at the bottom of the page. Please note that credit can only be granted to USA and Canada residents.

IMPORTANT: All fields are required for processing this application.

Contact Info
Company
Primary Contact
Title
Phone Number
Business email
Fax Number
Sales Contact
Technical Contact

Payable Info
Accts Payable Contact
Title
Phone
Accts Payable Email
Fax
I would like to
Years in business
Number of employees

Billing Info
Street Address
City
State/Province
Zip/Postal Code
Country

Shipping Info - Complete only if different from billing address
Street Address
City
State/Province
Zip/Postal Code
Country

References
Company (1)
Contact
Account #
Fax # only

Company (2)
Contact
Account #
Fax # only

Company (3)
Contact
Account #
Fax # only

Company (4)
Contact
Account #
Fax # only

Bank Info
Bank Name
Bank Manager
Phone
Fax
Address
City
State/Province
Zip/Postal Code
Country
Account #
Account Balance $
NSF Cheques	Yes	No

Please Read and Acknowledge
	I certify that the above information is true and complete to the best of my knowledge.
	I have attained the Age of Majority.
	I authorize you to check my credit and employment history and to provide and/or obtain information about credit experiences with me.
Comments
The items above must be checked for us to complete this request. By submitting this completed form, I acknowledge that I have read and understand the disclosures.

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