New Account Info - Ambassador Coffee Service

New Customer Information Form

Company Information

Company Name:
Department:
Street Address:
Street Name:
City:
Province:
Postal Code:

Bill To Details (if different):

Contact Information

Company Tel:
Company Fax:

	Name	Telephone	Email Address
*Main Contact*
*Order Contact*
*Accounts Payable Contact*

Billing Information


Are you PST Exempt?	If Yes then PST Number:
Are you GST Exempt?	If Yes then GST Number:

Do you use Purchase Orders?

Would you like your Statements and Invoice via e-mail rather than post mail?

Please choose one payment options below ...
	Charge account - Terms: Net 30 Days (cheque only)
	CCEO - Credit Card on file automatically processed with every order.
	CCAE- Credit Card on file automatically processed near end of month for all outstanding invoices.

Thank you for choosing Ambassador Coffee Service.
Your information will be kept secure.
If you selected a Credit Card Option we will fax you a form to acquire the details.