WELMS Account Opening

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General information

Company name *

City

Province / State

Postal code

Email address *

Business type

Established since

Preferred payment method

Delivery details (location / conditions)

Shipping address (if different)

City

Province / State

Postal code

Phone / Fax

Email address

Contacts

Accounts payable contact (name and email) *

Purchasing contact (name and email)

Technical contact (name and email)

President (name and email)

Additional information

Number of employees

Industry type

References

Reference 1 (name / company)

Reference contact 1

Phone / Fax 1

Reference 2 (name / company)

Reference contact 2

Phone / Fax 2

Reference 3 (optional)

Reference 4 (optional)

Additional reference 1_2

Additional reference 2_2

Additional reference 1_3

Additional reference 2_3

Authorization

Date *

Company name

Name *

Title

Address

Address (if different)

Phone

Fax

Exotaxes

Yes No

Comments / Notes