PRODUCTS SERVICES

Apply for an Account

Complete the credit application below to open a business account with Fluidseal. We'll follow up by email.

RUSH — Order pending Have an order waiting on this account? Tick this and we'll prioritize your application.

CREDIT CUSTOMER APPLICATION

Applicant Name *	Applicant Email *
Company Name
Billing Address
City	Prov.
Postal Code	Country
Phone	Fax
Website *	Company Email

SHIP-TO ADDRESSES Same as Bill To

Ship-to address is the same as the billing address.

Phone	Fax
Website	Company Email

PAYMENT METHOD

EFT / Wire Transfer

No action needed now. Once your account is approved, we'll email you Fluidseal's banking details (institution, transit & account numbers) so you can set up the EFT / wire transfer.

Cheque

Seriously? 😂 No judgment — cheques are welcome. We'll include remittance details with your invoices.

Credit Card (Visa / Mastercard)

Secure payment link. We accept Visa & Mastercard through a secure checkout link, so your card number never touches this form. We'll email you the link to complete payment — the secure checkout is being finalized and will be sent with your account confirmation.

American Express — not accepted Interac — not accepted

BUSINESS DETAILS

Business Structure
Type of Business	Year Established
GST	PST

CREDIT REQUEST Net 30 days

Estimated Monthly Purchases $

Credit Amount Requested $

A minimum of $500 in estimated monthly purchases is required for Net 30 credit terms. Enter $500 or more to continue.

CREDIT APPLICATION optional

Already have a completed Credit Application? Attach it here (PDF, image, spreadsheet… — max 7 MB) and skip the Contacts & Trade References fields below. Otherwise, fill those out instead.

CONTACTS email optional

Owner / President	Email
General Manager	Email
Purchaser / Buyer	Email
A/P Manager	Email

TRADE REFERENCES

Firm Name	Phone	Email
Firm Name	Phone	Email
Firm Name	Phone	Email

SPECIAL INSTRUCTIONS optional

Purchasing · Orders

PO required on all orders

Order confirmation required

Accounting · Invoicing

Email invoices to

Email statements to

Monthly statement required

Shipping · Tax

Delivery appointment required Tax exempt

Other instructions

Signed By *

Title *

Date *

Your application is emailed securely to Fluidseal. A copy is attached as PDF.