Business Credit Application

Company Information

Ship to Address*
Principal Owner Name*
Ship to Address Same as Sold to Address?*
Sold to Address*
A/P Contact Name*

Payment Information

Credit card payments - Only VISA & Mastercard accepted

EFT - Net 30

Payment Terms*
Credit Card Contact Name*

By providing credit card information I am allowing Sigvaris to charge outstanding amounts as per payment terms. 

When an order is placed, there will be a pre-authorization pending amount that will be temporarily held on the credit card for 48/72 hours to cover the estimated cost of the order & freight.  

The credit card will only be charged the amount of the invoice when the products are shipped. 

Please contact canada.ar@sigvaris.com for further information.

I certify that the above information is true to the best of my knowledge. If credit is granted we agree to abide by the payment terms issued. It is also understood that business relationships resulting from this application will be enforced in accordance with the laws of the province of Quebec.

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Signer Name*
Signature Date*

Dealer Portal Registration

Dealer Portal Online Ordering is a quick and easy way to place your orders online, instantly. There are no forms to complete or phone calls to place. Online ordering validates all SKU’s and verifies your order before you submit it. Once submitted a confirmation email with your order number and details will be sent to you. Please complete the registration process by providing us with current, complete and accurate information.

Would you like to delete all Dealer Portal accounts that were active prior to the change of ownership?*
Name of Designated Dealer Portal User*

Customer Care Redirect

Completed by CCR*
Region*

Regional Approval

Regional Manager*
Date*
Approved?*
Order Documentation
No File Chosen
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Authorization Email
No File Chosen
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Other Documentation
No File Chosen
File uploads may not work on some mobile devices.
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Customer Care - Account Creation

Account Opened By*
Date of Account Creation*
Separate by commas if multiple

Customer's Preferred Payment Method; Credit Card

Customer's Preferred Payment Method; EFT

Terms by Customer Class

06, 24 - Terms 15

09 - Terms 60

19 - Terms 14

22 - Terms N3

28 - Terms CC

52, 54 - Terms 35

Everything Except the Class' Above - Terms 10 or CT Depending Customers Preference

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Customer Care - DP Creation & Order Entry

Section Completed By?*
Completed Date*
Created DP Account?*
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Finance Team Approval

Finance User*
Date*
Approved?*

Customer's Preferred Payment Method; Credit Card, update Syspro account to CT

Customer's Preferred Payment Method; EFT

Terms by Customer Class

06, 24 - Terms 15

09 - Terms 60

19 - Terms 14

22 - Terms N3

28 - Terms CC

52, 54 - Terms 35

Everything Except the Class' Above - Terms 10 or CT Depending Customers Preference

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