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| REGISTRATION FORM
FOR OEM PURCHASING |
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Pacific Computer Supplies
Inc |
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| PRINTER
FRIENDLY |
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FAX: 1.866.230.9600 |
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| PLEASE CAREFULLY READ THE POLICIES PAGE BEFORE PROCEEDING |
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NAME: |
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| COMPANY
ADDRESS: |
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| PHONE
NUMBER: |
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| FAX
NUMBER: |
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| WEBSITE: |
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| EMAIL
ADDRESS: |
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PST # |
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GST # |
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| NATURE
OF BUSINESS: |
DISTRIBUTOR |
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SYSTEM BUILDER |
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CONSULTING |
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| TYPE
OF COMPANY |
PARTNERSHIP |
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SOLE PROPRIETORSHIP |
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CORPORATION |
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| ESTABLISHED
SINCE |
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NUMBER
OF YEARS AT PRESENT ADDRESS |
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| NAME
OF OWNERS |
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PHONE |
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PHONE |
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| FINANCIAL
INFORMATION |
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| BANK
NAME |
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ACCOUNT
NUMBER |
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| CONTACT
NAME |
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PHONE NUMBER |
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| BANK
ADDRESS |
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| CREDIT
CARD NUMBER |
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EXPIRATION |
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| CARD
HOLDER |
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CCV |
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| WHERE
DID YOU HEAR FROM US |
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| I………..……………… …by signing this application form agree
with the terms set out in the policies page. |
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| DATE |
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SIGNATURE |
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| PLEASE
FAX A COPY OF THE FOLLOWING DOCUMENTS : |
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| 1-
COMPANY REGISTRATION/ PST EXEMPT CERTIFICATE ( NO OEM
SALES WITHOUT IT) |
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| 2-
COMPANY CHEQUE ' MARKED VOID' FOR CHEQUE PAYMENTS |
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10-May-09 |
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| PCS WILL NOT
RESPOND TO INCOMPLETE APPLICATIONS |
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| 1005 CORTELL St, NORTH VANCOUVER, B.C.
V7P 2A2, CANADA TEL: 604.987.1900 |
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