• BUSINESS INFORMATION AS REGISTERED


























  • CONTACT INFORMATION


  • BANK REFERENCE














  • COMPANY CONTACTS


  • COMPANY REPRESENTATIVES / PRINCIPALS



  • BUSINESS REFERENCES

    Please provide at least 3 companies your business has established credit with previously






















































  • The undersigned hereby certifies that all the information on this form is correct and fully authorizes inquiry into the banking and business references provided within this application. Undersigned also fully understands and agrees to credit/payment terms of extended credit provided by BTL.