Professional Health Account Application
Please fill in the form below to apply for access to our full Professional Health catalog. We will contact you within two
business days to confirm your application.
Business name
Address
Postal Code
Prov. Tax Number
Name of Bank
Address of Branch
Date
City
Phone Number
G.S.T Number
Name of Bank
Buyer
Principal Supplier of Credit
Address
Phone Number
1.
2.
3.
Amount of Credit Required (Based on 2 month purchases) $
Northland Healthcare Products Limited customer credit policy is net invoice amount paid in 30 days. Accounts with past due balance will not be able to have new purchase to that account until the outstanding amounts have been paid. In signing this agreement, you are agreeing to these terms, and therefore agree to pay your account within 30 days.
Completed By
Accounting Contact
name
Postion
Phone Number
SUBMIT
Need help? Call us at 204-786-3345