Apply for an Account

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

CREDIT CUSTOMER APPLICATION

Company Name
Postal Code Enter postal code first — address auto-fills	Billing Address
City	Prov.	Country

CONTACTS

Owner / President

General Manager

Purchaser / Buyer

A/P Manager

BUSINESS DETAILS

Branch Office
Phone	Fax
Website	Email
Business Structure (Sole Ownership, Partnership, Corporation…)
Type of Business	Year Established
GST	PST

SHIP-TO ADDRESSES

PAYMENT METHOD

Wire Transfer Cheque Credit Card (Visa / Mastercard) American Express — not accepted Interac — not accepted

CREDIT REQUEST Net 30 days

Signed By

Title

Date

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