Customer Contact Form North Keg New Customer FormPlease fill out this form so we can open your file in our system. Legal Company Name*Billing AddressShipping Address (if different than billing address)Phone: OfficePhone: MobileEmail Principal Company Owners*Corporation ID#HST #Quantity of Kegs RequestedPlease enter the number of kegs you are interested in leasing. 20L30L50LCredit ReferencesPlease provide bank & credit references. (Name, Company Name, Email, Phone Number)Bank ContactCredit Reference #1Credit Reference #2Credit Reference #3Confirmation of EligibilityPlease provide your name and click the check box belowName & Title* First Last Title Form Approval* By checking the checkbox I certify that this information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions and credit references listed in this Credit Application to release necessary information to the company for which credit is being applied for to verify the information contained herein. CommentsThis field is for validation purposes and should be left unchanged.