Information submitted will be kept strictly confidential.
If a corporation or a partnership: Please complete
If sole proprietorship or individual, the following statement is required.
The applicant consent: By clicking the box below, I hereby consent to a routine verification by the Sansin Corporation if necessary.
Certification statement: In event this account becomes delinquent and is placed into the hands of a licensed collector or attorney for collection. By clicking the box below, I (we) agree to pay, in addition to the delinquent amounts and finance charges thereon, collection or attorney fees, including court costs, equal to 25% of the delinquent balance, or the maximum allowed under provincial/state law, whichever is less. Undersigned is Owner and/or Director of above named company.