To begin, Please let us know which staff member asked you to complete this form ?
*
Customer Information Form
Please complete this form as a New Customer or to Update your current information.
Customer Details:
Company Name (operating as)
*
Legal Company Name:
Main Contact
*
First Name
Last Name
Bill To: Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bill To: Contact Name
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
Ship To: Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Ship To: Contact Name
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
Are Purchase Orders Required ?
*
YES
NO
Preferred payment method
Cheque
Credit Card
EFT / Direct Deposit
Authorized Buyers:
Rows
Full Name
Email Address
Contact Number
1
2
3
Accounts Payable Contact | Invoices emailed to:
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
Statement Email:
PST Exempt Number
GST Exempt Number
Treaty Band Number
How did you hear about us?
*
Please Select
Online / Website
Colleague
Trade Show
Other
Please Specify
*
Which Socials do you use ?
Facebook (META)
Instagram
X (Twitter)
Tik Tok
Date
-
Month
-
Day
Year
Date
Signature
Continue
Continue
Should be Empty: