Legal Name of Firm:

Phone:

Trade Name:

Address:

City:

Province:

Postal Code:

Type of Business:

Is Business Corporated: Yes No

If Yes Date Incorporated:

NAMES, HOME ADDRESSES OF PRINCIPAL(S), SOLE PROPRIETORSHIP. OR PARTNERSHIP

Name:

Address:

Telephone:

Do you own?:

If Lease, Name of Landord:

Seating Capacity of Restaurant:

Length of Time In Business:

Bank Information:

Bank:

Account:

Account Name:

Branch:

Phone:

Trade References:

Name:

Address:

Phone Number:

Fax Number:

Name:

Address:

Phone Number:

Fax Number:

Name:

Address:

Phone Number:

Fax Number:

I/we authorize Burton Meats Limited, to contact all references given and inquire as to my/your credit history. Upon approval, I/we agree to abide by the terms and conditions of a sale pertaining to the products that I/we wish to purchase on credit. Terms are subject to change without notice.

Customers Signature of Approval:

Credit Manager Burton Meats Ltd:

(Terms Requested)

(Terms Granted)