Please print this form out and fax it to us

HOME LUMBER & BUILDING SUPPLIES
Division of Jawl Industries Ltd.
470 Ardersier Rd., Victoria. B.C. V8Z 7H7

Sales:
Fax:

Admin: 
Fax:		 475-3374
475-3394

475-0333
475-3364
Email: info@homelumber.net Website:www.homelumber.net
Toll Free:
1-877-933-3374
COMPANY NAME


 		PROPRIETORSHIP

PARTNERSHIP
How long in business
under present  name?  ______ yrs

CORPORATION
Date incorporated  ____________

STREET ADDRESS
CITY
PROV.
MAILING ADDRESS IF DIFFERENT FROM ABOVE


 		PHONE # POSTAL CODE
TYPE OF BUSINESS


 FAX # SOCIAL INSURANCE #
CELLULAR PHONE #


 		EMAIL ADRESS FEDERAL TAX # PROV. TAX #
PRINCIPALS: NAME


 		ADDRESS TITLE HOW LONG?
NAME


 		ADDRESS TITLE HOW LONG?
NAME


 		ADDRESS TITLE HOW LONG?
PREMISES
 LEASED-      MONTHLY RENT   $                                    
 OWNED-       MARKET VALUE    $                                   MORTGAGE    $                              BALANCE DUE    $
                           
  MORTGAGE HELD BY                                                          ADDRESS
BANK


 		BRANCH ESTABLISHED LINE OF CREDIT
CREDIT REFERENCES
ADDRESS
PHONE NO.
CREDIT REFERENCES
ADDRESS
PHONE NO.
CREDIT REFERENCES
ADDRESS
PHONE NO.
AFFILIATED COMPANIES
ADDRESS
PHONE NO.
PREVIOUS DEALING WITH THE COMPANY
YES NO CASH CHARGE


 AT WHICH BRANCH
 WHEN
STREET ADDRESS OF PREMISES UNDER CONSTRUCTION


 		CITY

LEGAL DESCRIPTION OF CONSTRUCTION ADDRESS
LOT


 		DISTRICT PLAN

SECTION

DETAILS OF FINANCING OF PROJECT
LENDER AMOUNT TYPE
ARE FINANCIAL STATEMENTS AVAILABLE TO US
YES NO

IF "NO" GIVE REASON
MONTHLY LIMIT REQUIRED PURCHASE ORDER REQUIRED
YES NO


We request credit from you for goods and/or services to be furnished by you and we agree if credit is given payment
shall be made by the 15th of the month following the month in which any such goods and/or services are furnished.
We further agree to pay all costs, charges and expenses of, and incidental to, all proceedings taken to collect monies
due and payable and unpaid or to enforce any personal guarantee or other security taken by you, all such costs,
charges and expenses to be determined and paid on a solicitor/client basis. If payment is not made within one month
of the month in which any such goods and/or services are furnished, the amount unpaid shall bear compound interest
at the rate of 2% per month (26.04% per annum) effective the 1st day of the month following the month in which any
such goods and/or services are furnished until paid. Either party may terminate this arrangement forthwith upon written
notice whereupon all balances, including interest and cost, shall become immediately due and payable.


Date

Signature

PERSONAL GUARANTEE


In consideration of Jawl Industries Ltd. extending credit to_________________________________________
(herein called the "applicant") the undersigned do hereby jointly and severally guarantee payment to
Jawl Industries Ltd. of all monies now or in the future owing to it by the applicant including all money due for
interest and cost and declare this to be a continuing unlimited guarantee which shall apply to any number of
transactions for this and other projects and shall remain in full force and effect notwithstanding any extensions of time,
compromises, or indulgences granted by Jawl Industries Ltd. to the applicant and the undersigned agree to
make payment of all money hereby guaranteed to Jawl Industries Ltd. whether or not Jawl Industries Ltd.
takes action against the applicant for recovery.

Dated _________ day of _______________ (year) _____


 Guarantor
At


 		(print name)
Witnessed Guarantor
(print name)

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