Telecom Computer - New Customer

Telecom Computer's agreements with the Tier-1 manufacturers preclude us from selling products to consumers and home based businesses.
*Required fields are marked with an asterisk()**
Corporate Information
Company Name:*
Address:*		City:*
		Province/Territory:*
Postal Code:*		Fax:
		Tel:*
Years in Business:*		No. of Locations:*
		No. of Employees:*
PST Exempt #:		GST Registration #:*
Principal Contact:*		Tel:*
		Email:*
Type of Business:*		DUNS#:
Website Address:*		Telecom Rep:*
Reason for Request:
Contacts
Accounts Payable:		Tel:
		Email:
Purchasing:		Tel:
		Email:
Other:		Tel:
		Email:

Bank Information
Bank Name:
Address:		City:
		Province/Territory:
Fax:		Years with this Bank:
Tel:
Account Manager:

Business References:
Name:		Address:
Tel:		Terms
Fax:		Terms
Name:		Address:
Tel:		Terms:
Fax:		Terms:
Name:		Address:
Tel:		Terms:
Fax:		Terms:

THE ABOVE INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE
Name:*		Date:

AGREEMENT

Applicant agrees that extension of credit by Telecom Computer Inc. (hereinafter "seller") shall be subject to and in consideration of the following terms and conditions:
Payments of all amounts due as evidenced by the account, shall be made no later than the due date as indicated on each invoice under the heading "terms. Telecom Computer standard terms provide for full payment 15 days after invoice date.

Should it be necessary to assign the account balance to a licensed collection agency or attorney for legal action, all subsequent collection charges, costs, and legal fees shall be paid by the applicant.

Applicant understands that seller will make its usual credit investigation and hereby waives any claim of privacy as to the information derived therefrom and authorizes applicant's bank, and credit references to release information as desired by seller.

By completing this application, the applicant individually warrants that they are duly authorized and empowered to borrow and to execute and carry out the terms of this agreement and all documents and instruments delivered by it pursuant to this agreement.

The undersigned agrees that all credit extended shall be deemed subject to the terms herein agreed to and such other terms as may be imposed from time to time by seller.

Do you agree to the above terms?:* Yes