INGRAM MICRO CANADIAN RESELLER APPLICATION CONTRACT

INGRAM MICRO CANADIAN RESELLER APPLICATION CONTRACT
PLEASE FAX COMPLETED APPLICATIONS TO:
All provinces except Québec: 905-755-1398
Québec only: 514-334-2701
OFFICE USE ONLY: IS#: LEAD #: CUSTOMER #:
ALL PAGES MUST BE COMPLETED IN FULL
*Do any owner(s)/officer(s)/principal(s)/shareholder(s) have or had an account with Ingram Micro worldwide? ˆ
Yes ˆ No If yes, Account Name:
Account Number:
Have any of the owner(s)/officer(s)/principal(s)/shareholder(s) filed for bankruptcy
before? ˆ Yes ˆ No If yes, please provide details:
♦ *PREFERRED METHOD OF PAYMENT (Check only one listed option)
i Prepaid (Visa & MasterCard only, Wire Transfer, EFT, Certified Cheque, Debit (at Pick-up counter only)
i Net 30 Terms, Please include most recent year-end audited financial statement. Credit Requested: $
Financial statement: Is a balance sheet and income statement. Financial statements not audited must be signed and dated by the company’s owner/officer.
The statement’s time period must also be indicated.
♦ GENERAL COMPANY INFORMATION
*Company Legal Name:
*Company Trade Name:
Company Web Address:
*Billing Address 1:
*Billing Address 2:
_______________________________________________________________________ ˆSuite / ˆUnit:
*City: ___________________________ *Province / State: _____________________ *Postal / Zip Code:
*Telephone N°: _________________________________ Ext.: _______________ Fax N°: ______
*Shipping Address 1: ____________________________________________________________________
*Shipping Address 2:
__________________________________________________________________________ ˆSuite / ˆUnit:
*City: ___________________________ *Province / State: _____________________ *Postal / Zip Code:
*Telephone N°: ________________________________ Ext.: ___________________ Fax N°: ______
*Type of Business: ˆ Sole Proprietorship ˆ Partnership ˆ Incorporated
* Number of Locations: *In business since: _________ Incorporated since:
Are you publicly traded? ˆ Yes ˆ No Exchange traded on: _______________________ Symbol:
Subsidiary or Parent Company Name: ____________________________________________________
*Landlord:
*Contact:
*Telephone
N°: _________________________________________ *Business Premises are: ˆ Owned ˆ Rented ˆ Leased
♦
BANK INFORMATION (This section must be fully completed)
*Name:
Address:
*City: _________________________ *Province / State: ______________________ *Postal / Zip Code:
*Telephone N°: ___________________________________ Ext.: _____________ Fax N°: _____
*Account Type: ˆ Business ˆ Personal *Account N°: Credit Line $:
INGRAM MICRO INC. REVISED 05/01/2009
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