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If you wish to open an account with SiliCycle, we need you to provide us with a credit application. To do so, please fill the form below, print it, sign it and finally send it back to us, either by email, at [email protected], or by fax, at 418 874-0355, to the attention of Manon Lapointe.

New credit application

All the fields preceded by a * are required.

Company type


Sole Proprietor


Bank references

Companies with which you already have an open account (with exception of VWR, Fisher, Dell, Sigma-Aldrich, Staples and phone company) :

1st company
2nd company
3rd company
4th company
5th company

Terms and Conditions

All merchandise purchased remains the property of SiliCycle® Inc. until such time as all invoices for the merchandise have been paid in full. No returns will be accepted without prior authorization. Payment is due net 30 days after the date of invoice. Additional fees of 2% per month (24% per year) will accrue on all accounts past due. If any payment is in default and it becomes necessary to hire a recovery agency or a lawyer, the client accepts to pay, in addition to the outstanding balance, recovery fees equal to 20% of the balance in capital and interests.

I hereby authorize SiliCycle® Inc. to inquire about the company and to obtain any information that SiliCycle® Inc. considers relevant regarding this new account application.

I declare that the information contained above is true and correct.

Signature of the authorized person from the company

Print name



Note : this credit application will be automatically refused if :

The customer changes something with regards to our terms and conditions as stated on this form OR if the present credit application is not signed.