Corporate Account Form

Business Name:______________________________

Address:_____________________________________________

Contact Name:____________________________

Contact Phone:_______________ Ext:______ Fax:_____________

The privilege of ordering is to be extended to:_________________________

Preferred method of payment is:

________ Company Cheque
________ Visa
________ MasterCard
________ American Express

Credit Card Number:____________________________ Expiry Date:______

Name as appears on Credit Card: ________________________

OUR AGREEMENT:

I/We the applicant(s) hereby:

1. Request that an account be opened for the Company listed above with Blooming Wellies. It is agreed that the Company, Contact Name and Privilege of Use names listed above, will be liable for all charges incurred through the use of this account.
2. It is understood that all charges are due and payable in full immediately upon receipt of the Blooming Wellies monthly statement. Outstanding accounts will bare interest of 1.5% per month.
3. For each cheque or draft which is returned or honored immediately for its full amount, Blooming Wellies may charge the account $20.00 to cover costs.

                        Customer,

                                                    __________________________                             _____________
         Signature                                                       Date

Please send completed form either by fax 905-657-8985  
email info@bloomingwellies.com
Or Mail to 525 Brooker Ridge, unit 102 Newmarket, ON L3X 2M2