Welcome to Memory - Clip ® Canada Homepage
Memory Clip ®
world wide

Store Credit Application !


Please continue the application process by filling out
the Credit Application Form below.

Fields with an asterisk * are required.






  Credit Application:
*Legal Business Name:
*Address:
*City:
*Postal Code:
*Date Business Established: - in the format DD/MM/YYYY
*Organization:
*Vendors Permit:
(This is a numeric field. When entering your
Vendors Permit number do not include the dash)

List full names, address and title of
all officers partners or owners:
*Name:
*Position:
*Address:
*Phone:

Name:
Position:
Address:
Phone:

Name:
Position:
Address:
Phone:

Bank Information:
*Bank:
*Bank Location:
*Bank Phone:
*Bank Fax:
*Bank Contact:
*Account Number:

Trade Information:
Company:
Location:
Phone:
Fax:
Contact:

Company:
Location:
Phone:
Fax:
Contact:

Company:
Location:
Phone:
Fax:
Contact:


I/We expressly consent to Indigo Advertising Distribution LTD or VERI-CHEQUE LTD. to obtain any reports containing credit or personal information that is required in obtaining credit form Indigo Advertising Distribution Ltd.

I/WE declare that the information given on this application is true and accurate in every aspect.

This declaration is made for the purpose of obtaining credit from Indigo Advertising Distribution LTD. and will remain confidential.

TEL (403) 398 - 2485 FAX: (403) 724 - 0091
*Name & Position: