Account Opening

Bill To (If different than above)

2

Bill To (If different than above)

Address:

City:

Province:

Postal Code:

Ship To (If different than above)

3

Ship To (If different than above)

Address:

City:

Province:

Postal Code:

CONTACTS

4

CONTACTS

Owner

4.1

Owner

Name:

E-mail:

Value is required

Telephone:

Accounts Payable

4.2

Accounts Payable

Name:

E-mail:

Value is required

Telephone:

Invoices/Statements to
be sent to

4.3

Invoices/Statements to be sent to

Name:

E-mail:

Value is required

Telephone:

Purchaser/Buyer

4.4

Purchaser/Buyer

Name:

E-mail:

Value is required

Telephone:

EDI

4.5

EDI

Name:

E-mail:

Value is required

Telephone:

Delivery

4.6

Delivery

Name:

E-mail:

Value is required

Telephone:

INFORMATION

5

INFORMATION

Type of Business:

Products of Interest:

SHIPPING REQUIREMENTS

6

SHIPPING REQUIREMENTS

Does your location have a truck level shipping/receiving dock? If not, tailgate charges may be incurred to all transport deliveries (Max 75$)*

Yes

No

Does your location require Inside Delivery (Billed by weight - Max 75$)? *

Yes

No

Does your location accommodate a 53’ trailer (for freight deliveries only)? *

Yes

No

Does your location require an appointment ($35 additional charge)?*

Yes

No

Additional Special Instructions:

Delivery hours

6.1

Delivery hours

From:

To:

Monday through

Fri

Sat

Sun

METHOD OF PAYMENT

Method of Payment

Credit Card

EFT (Electronic Fund Transfer)

REQUESTED PAYMENT TERMS

Requested Payment Terms

Prepayment

Credit Line

Estimated Monthly Purchases ($):

FINANCIAL & BANKING INFORMATION

7

FINANCIAL & BANKING INFORMATION

Bank:

Address:

Account #:

Branch #:

Contact Person:

Telephone:

E-mail:

Value is required

TRADE REFERENCES

8

TRADE REFERENCES

Company Name

Contact Person

E-Mail

Value is required

Telephone

GENERAL TERMS

9

GENERAL TERMS

a) For AMG Medical Inc. to establish an open line of credit based on this application, the applicant agrees to pay for all purchases in accordance with AMG Medical's terms of sale. The applicant agrees to
reimburse AMG Medical for all costs for collection agencies or attorney fees to collect any debt and to pay 2% per month for any late charges assessed on past due invoices.
b) Orders for less than the minimum $250.00 will be accepted but incur an admin fee of 25$
c) * May add additional transit time (typically 1 day). Charges are subject to change without notice.

Name (Print):

Title:

Signature:

Date (DD/MM/YYYY):

ADMINISTRATION (To be completed by Sales)

10

ADMINISTRATION (To be completed by Sales)

Sales Representative:

Applicable Promotion (HC Promo)

Yes

No

B2B Setup

Yes

No

APPROVED PAYMENT TERMS (Based on credit check, to be completed by Accounting)

11

APPROVED PAYMENT TERMS (Based on credit check, to be completed by Accounting)

Approved Payment Terms

Prepayment

Approved Payment

Term:

Credit Limit:

ACCOUNT OPENING

COMPANY INFORMATION

Bill To (If different than above)

Ship To (If different than above)

CONTACTS

Owner

Accounts Payable

Invoices/Statements to
be sent to

Purchaser/Buyer

EDI

Delivery

INFORMATION

SHIPPING REQUIREMENTS

Delivery hours

METHOD OF PAYMENT

REQUESTED PAYMENT TERMS

FINANCIAL & BANKING INFORMATION

TRADE REFERENCES

GENERAL TERMS

ADMINISTRATION (To be completed by Sales)

PRICE LEVEL

TYPE OF BUSINESS (CHECK ONE)

APPROVED PAYMENT TERMS (Based on credit check, to be completed by Accounting)

Nos marques

Acheter par produit

Entreprise

Langue

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

Parcourir par catégorie

Nos marques

Best-sellers

ACCOUNT OPENING

COMPANY INFORMATION

Bill To (If different than above)

Ship To (If different than above)

CONTACTS

Owner

Accounts Payable

Invoices/Statements tobe sent to

Purchaser/Buyer

EDI

Delivery

INFORMATION

SHIPPING REQUIREMENTS

Delivery hours

METHOD OF PAYMENT

REQUESTED PAYMENT TERMS

FINANCIAL & BANKING INFORMATION

TRADE REFERENCES

GENERAL TERMS

ADMINISTRATION (To be completed by Sales)

PRICE LEVEL

TYPE OF BUSINESS (CHECK ONE)

APPROVED PAYMENT TERMS (Based on credit check, to be completed by Accounting)

Nos marques

Acheter par produit

Entreprise

Consultez nos produits populaires:

112-110 - Diapasons MedPro

112-110 - Diapasons MedPro

Invoices/Statements to
be sent to