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Residential Credit Application

  • Contact Information

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Bank Reference

  • Sole Propietor Only

  • If Corporation, use Business Credit Application
  • Trade References

  • CREDIT TERMS - NET 30 DAYS - FINAL CREDIT TERMS TO BE GRANTED AND APPROVED BY PRIMEMAX ENERGY INC.
  • This field is for validation purposes and should be left unchanged.

In compliance with the Privacy Act, this information is not distributed to any other party, or used in any other way, except for the purpose stated above. This information is considered private and confidential.

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