INGRAM MICRO CANADIAN RESELLER APPLICATION CONTRACT

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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 Page - 2
INGRAM MICRO CANADIAN RESELLER APPLICATION CONTRACT PLEASE FAX COMPLETED APPLICATIONS TO: All provinces except Québec: 905-755-1398 Québec only: 514-334-2701 ♦ NAME OF OWNERS/OFFICERS * Name: *Position: Date of Birth: *Address: ALL PAGES MUST BE COMPLETED IN FULL *City: ___________________________ *Province / State: ____________________ *Postal / Zip Code: Name: Address: Position: Date of Birth: City: ____________________________ Province / State: ____________________ Postal / Zip Code: *Company Name: ___________________________________________________________________ *Telephone N°: ____________________________________ Fax N°: S.I.N.: ♦ TRADE REFERENCES (Related industry purchases during the past 12 months – if available) *Address: 1Suite / 1Unit: *City: ____________________________ *Province / State: _____________________ *Postal / Zip Code: C r e d i t L i n e $ : P a y m e n t T e r m : _ _ _ _ _ _ _ _ _ _ Company Name: Address: 1Suite / 1Unit: City: ____________________________ P r o v i n c e / S t a t e : P o s t a l / Z i p C o d e : Telephone N°: __________________________________ Fax N°: C r e d i t L i n e $ : P a y m e n t T e r m : _ _ _ _ _ _ _ _ _ _ Company Name: Address: 1Suite / 1Unit: City: ____________________________ P r o v i n c e / S t a t e : P o s t a l / Z i p C o d e : Telephone N°: __________________________________ Fax N°: C r e d i t L i n e $ : P a y m e n t T e r m : _ _ _ _ _ _ _ _ _ _ ♦ CONTACTS (Authorized to purchase or have access to information from Ingram Micro) *Accounts Payable Contact: _______________________________ *Telephone N°: ____ *E-mail Address: Name: _________________________ E-mail Address: Position: __________________ Telephone N°: Name: _________________________ Position: __________________ Telephone N°: E-mail Address: INGRAM MICRO INC. REVISED 05/01/2009 Page - 3
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INGRAM MICRO CANADIAN RESELLER APPLICATION CONTRACT

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