Register Now! Application Form COMPANY NAME(Required) TRADE NAME NUMBER OF YEARS IN BUSINESS(Required) TYPE OF OWNERSHIP(Required) CORPORATION PARNERTSHIP ROPRIETORSHIP LIMITED OTHER DATE OF INCORPORATION:(Required) MM slash DD slash YYYY Hours of Operation(Required) COMPANY PHONESHIPPING CONTACT NAME SHIPPING CONTACT EMAIL SHIPPING ADDRESS(Required) SHIPPING PHONE(Required)CITY(Required) POSTAL CODE(Required) FAXACCOUNTS PAYABLE CONTACT NAME(Required) BILLING ADDRESS(Required) CITY(Required) POSTAL CODE BILLING EMAIL ADDRESS(Required) BILLING PHONELIST EACH PRINCIPAL AND CONTACT INFORMATIONNAME(Required) Phone(Required)TITLE(Required) EMAIL(Required) NAME PhoneTITLE EMAIL BANKING INFORMATIONBANK NAME TRANSIT# BRANCH ACCOUNT # CREDIT CARD INFORMATIONBANK NAME CARD TYPE CARD #EXP DATE MM slash DD slash YYYY NAME ON CARD SIGNATURE DATE MM slash DD slash YYYY Payment Option Pre-Authorized by Bank Account and Email Billing Pre-Authorization by Credit Card and Email Billing Cheque CREDIT REFERENCESCOMPANY NAME(Required) EMAIL(Required) ADDRESS(Required) PHONE(Required)COMPANY NAME EMAIL ADDRESS PHONETERMS AND CONDITIONS Accounts are billed on the 15 and the last day of each month, balance is due and payable upon receipt and becomes overdue in 20 days. Interest in overdue accounts will be charged 2% per month on all unpaid balances. Amounts outstanding over 60 days will be considered delinquent and will be charged to your credit card. Account will then be put on C.O.D. The Applicant Agrees to reimburse CCE for all reasonable fees, including legal and collections fees. Authorization I/We have read and understand the terms and conditions of credit detailed herein and Agree to abide by them. We also understand that we are personally responsibly and liable for payment of all services provided by CCE Canada Courier Express Ltd.SIGNATURE:(Required) TITLE:(Required) Date(Required) MM slash DD slash YYYY CCE COMPANY USE ACCOUNT # CREDIT LIMIT: DATE AUTHORIZED BY: SALES REP:
