New Customer Form
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2Account Executive:
Customer No.:
Updated
By:
Date:
Ottawa
Vancouver
Montreal
Halifax
Walnut, CA. U.S.A.
Calgary
Toronto
Tel: 613-746-8227
Tel: 888-908-7368
Tel: 604-303-0206
Tel: 514-333-6538
Tel: 902-468-0030
Tel: 403-450-3434
Tel: 905-470-0082
Fax:613-746-8679
Fax:888-316-7383
Fax:604-303-0207
Fax:514-333-6549
Fax:902-468-0040
Fax:403-450-3435
Fax:905-470-3183
NEW CUSTOMER FORM
Registered Business Name: ____________________________________ Doing Business As: _______________________________________
Address: ________________________________ City: ________________________ Province: __________ Postal Code: ________________
Phone: ___________________________ Fax Day: __________________________ Email Address: _________________________________
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Business Type: (Check One)
Limited Company
Partnership
Proprietorship
Date of Incorporation: _________________________
Date Business Started: __________________________
Annual sales volume: __________________________
Estimated Monthly Purchase: _____________________
Other locations and/or associated Companies
Name: ___________________________________ Address: __________________________________ Phone: _____________________
Name: ___________________________________ Address: __________________________________ Phone: _____________________
Principals (Partners / Owners)
Name: _________________________________________
Title: ______________________________
Address: _______________________________________City / Prov: ____________________________ Postal Code: ____________
Tel: _________________________________ Fax: __________________________________
Name: _________________________________________
Title: ______________________________
Address: _______________________________________City / Prov: ____________________________ Postal Code: ____________
Tel: ________________________________ Fax: __________________________________
Company Information
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Retail
VAR
Consultant
System House
Wholesaler
Chain stores
Other (Please Specify): _________________
Purchaser / Buyer : ________________________________________ A/C Payable: ____________________________________________
Number of Employees: _________________
Number of Sales Personnel: _____________________
How did you learn about ELCO? (Please check one)
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Trade Magazines
Web site
Referral
Trade Shows
Other (Please Specify): _________________
New Customer Form
(PK-02-12)
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Parent category: Business