NORTHLAND HEALTHCARE PRODUCTS LIMITED

Professional Health Account Application

Please fill in the form below to apply for access to our full Professional Healthcare Pricelist. 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

Position

Phone Number

SUBMIT

START OVER

Need help? Call us at 204-786-3345