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INGRAM MICRO CANADIAN RESELLER APPLICATION CONTRACT

INGRAM MICRO CANADIAN RESELLER APPLICATION CONTRACT

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SIGNATURE __________________________________________ Title ___________________________ Date _____/ _____/______<br />

(Owner/Officer/Principal)<br />

m m d d y y y y<br />

ADMINISTRATION FEE AUTHORIZATION: (Cardholder must be one of the Owners / Officers / Principals on the application)<br />

Cardholder Name:<br />

Check One: ˆ<br />

Visa ˆ MC - - - Expiry: -<br />

I hereby authorize Ingram Micro to<br />

debit my Credit Card for an<br />

account setup fee of $195.00 + applicable tax as agreed. I acknowledge this transaction is for account setup purpose only and is nonrefundable.<br />

SIGNATURE ___________________________________________ Title __________________________ Date _____/ _____/______<br />

(Owner/Officer/Principal) mm dd yyyy<br />

.<br />

<strong>INGRAM</strong> <strong>MICRO</strong> INC. REVISED 05/01/2009<br />

Page -5

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