Name as appears on
Credit Card: ________________________
I/We the applicant(s) hereby:
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.
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.
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
__________________________ _____________ Signature
Please send completed form either by fax
905-657-8985 firstname.lastname@example.org Or Mail
to 525 Brooker
Ridge, unit 102 Newmarket, ON L3X 2M2