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Company name  Address Contact Person Title City State/Province/Country Zip/Postal Code E-Mail Address Phone No. Fax No. Ship To (if Deferent from Above) Full Address Name of Owner, or Officer Title About Your Bank Bank Name Address City-State/Province Zip/Postal Code Phone No. Fax No. Account No. Contact Person Trade References Company Name (1) Contact Person (1) Phone No. (1) Fax No. (1) Company Name (2) Contact Person (2) Phone No. (2) Fax No. (2) Company Name (3) Contact Person (3) Phone No. (3) Fax No. (3) Please choose one Sales Tax (Ontario Businesses Only)                               Corporation                                           Partnership                                         Sole Proprietorship     Exempt       Taxable  Tax No. Filled By Date Special Instruction Note : FOB: Our plant, Mississauga, Ontario, Canada Claims for damage sustained in transit should be made promptly to your local carrier. Domestic Terms: Net 30 Days on Approved Credit. If you can't read the word, Reload Image Word Verification above, not case sensitive:  Thank you for taking the time to contact Product Support Team at Thermidaire!