Credit Application.

If you do not have an existing account with Jutzi Water Technologies, you will first need to fill out our credit application. The form below can be filled out and submitted electronically or you may print it out, fill it out by hand and deliver to our office.

Jutzi Water Credit Application

*indicate mandatory fields

Company Name *

Company Address *

Company Phone # *

Postal Code *

Type of Ownership *

Number of Years *

BANKING INFORMATION

Name of Bank (Primary) *

Bank Address *

Name of Bank (Secondary)

Bank Address

CREDIT INFORMATION

Type of Business and/or Reason For Credit *

Invoice Email Address *

Requested Credit Limit (Monthly Average Purchases) *

CREDIT REFERENCES

Reference #1 - Name *

Reference #1 - Address *

Reference #1 - Phone # *

Reference #2 - Name *

Reference #2 - Address *

Reference #2 - Phone # *

Reference #3 - Name *

Reference #3 - Address *

Reference #3 - Phone # *

APPLICANT’S INFORMATION

Applicant’s Name *

Position *

Today’s Date *

Terms of sale, including terms of payment and charges, for each purchase are agreed to be those specified on the face of each invoice. Interest is calculated at 2% per month or at 25% per annum for past due accounts. The customer hereby agrees to pay all costs of collection or legal fees should such action be necessary due to non-payment. Authorization is hereby given to Jutzi Water Technologies to obtain such credit information and reports regarding the undersigned from others as permitted by law.

0 + 5 = ? Please prove that you are human by solving the equation *

Water Treatment Credit Application in PDF

Click Here to Download Credit Application in Hard Copy Form

Email or Fax Your Form

If you’ve completed the hard copy version of our form, it can be delivered to our office at:

525 Wright Boulevard
Stratford, ON
N4Z 1H3
Fax: 519-814-9288

Have Questions? Contact Us!

If you have any issues or questions regarding the form, please feel free to contact our office through our email form located on our Contact Page or call us between 8:00 AM and 5:00 PM at either of these numbers:

Local: 519-814-WATER (9283)
Toll-Free: 1-833-299-WATER (9283)

Mission Statement.

Do our best.
Do what’s right.
Treat others as we’d like to be treated ourselves.

New Customer?

Credit Application.

Jutzi Water Credit Application

Water Treatment Credit Application in PDF

Email or Fax Your Form

Have Questions? Contact Us!

Mission Statement.

Telephone:

Address:

Office Hours: