Residential Credit Application

  • Contact Information

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Bank Reference

  • Sole Propietor Only

  • If Corporation, use Business Credit Application
  • Trade References

  • CREDIT TERMS - NET 30 DAYS - FINAL CREDIT TERMS TO BE GRANTED AND APPROVED BY PRIMEMAX ENERGY INC.

In compliance with the Privacy Act, this information is not distributed to any other party, or used in any other way, except for the purpose stated above. This information is considered private and confidential.