Informations sur le nouveau compte client

Devenez un client vérifié avec Verduyn pour des avantages tels que l’historique des achats et la recherche de services.

« * » indique les champs nécessaires

X/Twitter

Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.

Business Information

Legal Business Name*

Business Trade Name(s)

(if applicable)

Type of Business

Sole Proprietor

Partnership

Corporation

Individual

Primary Business Phone*

Primary Business Email*

Business Mailing Address*

Adresse postale Adresse ligne 2 Ville Province / State Postal Code / ZIP Pays

Business Shipping Address (if different from Billing Address)

Business Shipping Address

Adresse postale Adresse ligne 2 Ville Province / State Postal Code / ZIP Pays

Shipping Address

Primary Contact

Primary Contact Name*

Prénom Nom

Primary Contact Phone

(if different from Primary Business Phone)

Primary Contact Email

(if different from Primary Business Email)

PO Numbers Required?*

Yes

P.O. Contact

P.O. Contact Name*

Prénom Nom

P.O. Phone*

P.O. Email*

Purchasing Contact (optional)

Purchasing Contact Name

Prénom Nom

Purchasing Contact Phone

Purchasing Email

Purchasing Contact (optional)

Accounts Payable Contact (optional)

Accounts Payable Contact Name

Prénom Nom

Accounts Payable Phone

Accounts Payable Email

Accounts Payable Contact (optional)

Additional Info

HST/GST Reg. #:

Do You Have a Canadian Tax Exemption?

If yes, we will contact you for further details.

Yes, I have a tax exemption.

Would you like to apply for credit terms?

Yes, please contact me about credit terms for my account.

Would you like to join our mailing list to receive exclusive discounts and promos?

Yes, I want exclusive offers and event info.