Account Setup Form

LICENSEE INFORMATION

ENCRYPTED SECURITY
CONTACT NAME*

First NameLast Name
COMPANY*
AGCO NUMBER*
EMAIL ADDRESS*
USED FOR BILLING / DELIVERY CONFIRMATION
DELIVERY ADDRESS*

Street Address

Street Address Line 2

CityProvince

Postal Code
DELIVERY NOTES (OPTIONAL)
UPLOAD DOCS (OPTIONAL)

Cancelof
ACCOUNT NOTES (OPTIONAL)
PAYMENT INFORMATION
PAYMENT TYPE*

CREDIT CARDREQUEST TERMS (CREDIT APPLICATION)
PAYMENT TERMS
A MEMBER FROM OUR ACCOUNTING TEAM WILL BE IN TOUCH ON THE NEXT BUSINESS DAY. ORDERS WILL NOT BE PROCESSED UNTIL TERMS ARE ESTABLISHED.
CREDIT CARD INFORMATION
UPLOAD CARD FRONT (ENCRYPTED)*

Cancelof
UPLOAD CARD BACK (ENCRYPTED)*

Cancelof
CREDIT CARDS WILL BE PROCESSED AT THE TIME OF ORDERING AND AN EMAIL RECEIPT WILL BE ISSUED. CREDIT CARD AUTHORIZATION REMAINS IN EFFECT UNTIL A REQUEST TO CANCEL IS RECEIVED.
SIGNATURE*

Clear
Should be Empty:

LICENSEE INFORMATION