Ouverture de Compte

1
First and Last Name* This field is required.Please ensure that your name is listed among those of the shareholders in the business register (REQ)
First name
Last name
2
Your email address * This field is required.
3
Payment TermsWhat is your preferred payment solution?
Pre-authorized payments (simplified account opening, no credit granted )
Net 7 days or more (Credit check required)
4
Quebec Enterprise number(NEQ)* This field is required.
Example: 1178592060
5
Operating Name of Your Business
6
Business Phone Number* This field is required.
7
Billing Address* This field is required.
Address line 1
Address line 2
City
Province
Postal code
Please Select
Please Select
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Lesotho
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Lithuania
Luxembourg
Macau
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Malawi
Malaysia
Maldives
Mali
Malta
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Martinique
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Mauritius
Mayotte
Mexico
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Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
Contact at Accounting* This field is required.
First name
Last name
Email
Phone
9
Delivery Address* This field is required.
Address Line 1
Address line 2
City
Province
Postal code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Contact at Purchasing* This field is required.Please enter the contact details of the person responsible for purchasing.
First name
Last name
Email
Phone
11
Lunch Time DeliveryDo you accept deliveries between 12:00 PM and 1:00 PM?
YesNo
12
Delivery Schedule* This field is required.Please enter the first and last times at which you accept deliveries for the selected day (in a 24h format). You must include a zero if the time is before 10:00 (e.g., 0900 for 9:00 AM).
13
Weekly Purchase Volume.Please enter an approximate amount in dollars.
14
Bank ReferencesPlease provide the information for your financial institution.
Name of the institution
Transit number
Institution number
Account number
First and last name of the account manager
Phone number of your institution's branch
15
Authorization for Bank ReferencesThe signer hereby consents that, upon simple presentation of this document, the previously mentioned financial institution provides Nepco Inc. Tracy (Nepco), Groupe Alimentaire Nordique Inc., Gilles Ferron Inc. (or any authorized intermediary) with references pertaining to the business as well as to himself.
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16
Credit References 1/2* This field is required.Please provide the requested information about a supplier that grants you credit.
Name of supplier
Email
Phone
Weekly purchasing average
17
Credit References 2/2* This field is required.Please provide the requested information about a supplier that grants you credit.
Name of supplier
Email
Phone
Weekly purchasing average
18
Terms & Conditions* This field is required.
19
Signature
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20
Financial InstitutionPlease fill in with the bank details of the account to be debited.
Institution number (Ex.: 123)
Transit number (Ex.: 12345)
Account number (Ex.: 1234567)
21
Pre-Authorized Payments Terms & Conditions* This field is required.
22
SignatureBy signing this you allow Nepco Inc. and it's subsidiaries to debit from the account to which you have provided the coordinates in the previous form.
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23
Do you have a sales representative?If you have a representative, please enter their name below.
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