Carkner Office Supply

Form for establishment of an account

The obligatory fields are marked with a *

Information on the Applicant
Your name:	*
Your title:
Your email address:	*

Company name:	*
Name of operation (if different):
Person in charge of payable accounts:	*
Person in charge of purchases:	*
Type of company:	*
Number of years in business:	*
Number of employees:	*
Language:	French English
Do you accept that out-of-stock items are sent later on?	Yes No

Monthly account status
Do you need monthly account status notifications?	Yes Yes
If yes, indicate the following:
Email Address:
Fax Number:

Address of business (invoicing)
Address:	*
City:	*
Province:	*
Country:	*
Postal code:	*
Telephone:	*
Fax:	*

Shipping address (if different)
Address:
City:
Province:
Country:
Postal code:

General Information
Obligatory Order No? Yes No
Have you ever had an account with us? Yes No If yes, please enter your old number :
Goods for resale? Yes No If yes, please enter the PST:
Amount Required:	$ *
	Format: 0.00 $
Potential annual purchase volume:	$ *
	Format: 0.00 $
With who would you like to do business in your area? (Consult list)

Business References
	Company	Name of contact	Telephone and fax
1.	*	*	Tel.:	*
			Fax:
2.			Tel.:
			Fax:
3.			Tel.:
			Fax:

CONDITIONS

We authorize Carkner Office Supply to make any credit verification you will deem necessary at the time of the opening of the account and at any time you will deem necessary after. We authorize Carkner Office Supply to exchange credit information with any authorized person.

To contact us dial (613) 632-7000