REGISTRATION FORM FOR OEM PURCHASING
Pacific Computer Supplies Inc
                                     
PRINTER FRIENDLY        newaccounts@wholesalesoftware.ca
                               PLEASE CAREFULLY READ THE POLICIES PAGE BEFORE PROCEEDING
COMPANY NAME:            
COMPANY ADDRESS:            
PHONE NUMBER:            
FAX NUMBER:            
WEBSITE:            
EMAIL ADDRESS:            
PST #     GST #    
NATURE OF BUSINESS:        DISTRIBUTOR           SYSTEM BUILDER             CONSULTING  
TYPE OF COMPANY        PARTNERSHIP   SOLE PROPRIETORSHIP           CORPORATION  
ESTABLISHED SINCE                           NUMBER OF YEARS AT PRESENT ADDRESS  
NAME OF OWNERS       PHONE    
      PHONE    
FINANCIAL INFORMATION
BANK NAME      ACCOUNT NUMBER      
CONTACT NAME            PHONE NUMBER      
BANK ADDRESS            
CREDIT CARD NUMBER         EXPIRATION  
CARD HOLDER         CCV   
WHERE DID YOU HEAR FROM US          
I………..………………  …by signing this application form agree with the terms set out in the policies page. 
DATE     SIGNATURE      
PLEASE FAX A COPY OF THE FOLLOWING DOCUMENTS :
 COMPANY REGISTRATION/ PST EXEMPT CERTIFICATE OR BUSINESS LICENSE
  10-May-09
                      PCS WILL NOT RESPOND TO INCOMPLETE APPLICATIONS
    Address: 1005 Cortell Street, North Vancouver, B.C. V7P 2A2, Canada TEL: 604.987.1900