Date: Contact: Company:
Phone: Fax: E-mail:
Ownership Type:   Corporation   Partnership   Sole Proprietor
Do you require persons ordering maps to use PO Numbers  Yes  No
Our terms are 30 days from invoice date. Do you provide payment within 30 days?  Yes  No
Mailing Address:
Shipping Address:
Our GST # is 817271315RT0001
Bank Name: Bank Contact: Bank Phone Number:
Business References
 Contact  Company  Phone/Fax #
Credit is offered to the above stated company on the following condition:
  • If Map Town has not received payment within 45 days of the date of any invoice made out to the above company, then Map Town will be allowed to debit a MasterCard or Visa belonging to this company or the owner(s) of this company for the full amount owing on the invoice(s).
Credit Card Number: Credit Card Expiry Date: CC Security Code:
I also state that I will keep Map Town up to date with any credit card changes
Permission is hereby given by (print name)
(sign name)
Status of this person in company Owner Director Partner Manager

Please fill out and then print this form and fax it to Map Town

100 - 400 5 Avenue SW, Calgary, AB T2P 0L6
Toll-free (877) 921-6277 | Tel (403) 266-2241 | Fax (403) 266-2356