Credit Application Form

Please use this form to apply for a new account with S. Marino Manufacturing Ltd. by mail or fax. You will receive confirmation after submission with details of your account. Follow-up by regular mail or phone may be necessary.

Note: Orders will be cash in advance until credit is approved.

Marino Manufacturing Ltd.
59 Talman Court
Concord, Ontario, Canada L4K 4L5

Phone: (905) 669-9949     Fax: (905) 669-5750
Toll Free (U.S.A. and Canada): 1-800-265-6267

E-mail: info@marinomop.com
Website: www.marinomop.com

Company Information:
Company Name:    
Company Phone: (xxx) xxx-xxxx  
Company Fax: (xxx) xxx-xxxx  
Street Address: Mailing Address:
City, Prov: City, Prov:
Postal Code: Postal Code:
 
Your Name: Position/Title:
Phone: (xxx) xxx-xxxx  
Best Time to Call: E-Mail Address:
 
Federal ID
Sales Tax #:		 GST #
(Canada Only):

Trade Reference Information:
 First Reference
Name:    
Address: Account Number:
City, Prov: Point of Contact:
Postal Code: Phone Number:
    Fax Number:

 Second Reference
Name:    
Address: Account Number:
City, Prov: Point of Contact:
Postal Code: Phone Number:
    Fax Number:

 Third Reference
Name:    
Address: Account Number:
City, Prov: Point of Contact:
Postal Code: Phone Number:
    Fax Number:

Bank Information:
Name:    
Address: Account Number:
City, Prov: Point of Contact:
Postal Code: Phone Number:
    Fax Number: