Account & credit application

Open an account at Techni+Contact & AMX Canada

Become a partner and open a direct account with us online, in person, or by phone. Opening an account is fast and easy.

Detailed account & credit opening form

Legal company name*

Doing business as

Amount of credit required*

Billing

Billing address*

City

Province / State

Postal code / Zip Code

Country

Email address*

Phone number and extension*

Website

Shipping

Shipping address

City

Province / State

Postal code / Zip Code

Country

Additional addresses

Person in charge of shipping

Phone number*

Extension

Email

Special instructions

Returns

Person in charge of returns

Email

Owner(s) and Shareholder(s)

Owner(s), shareholder(s)*

Phone number and extension : owner(s), shareholder(s)

Email: owner(s), shareholder(s)

Person(s) authorised to purchase

Title : person(s) authorised to purchase

Email : person(s) authorised to purchase

Person(s) in charge of accounts payable

Phone number and extension : person(s) in charge of accounts payable

Email : person(s) in charge of accounts payable*

Email address to send invoices*

Provincial Tax No*

Federal Tax No*

Banking information

Bank name

Bank branch

Account No

Phone number and extension

Name of beneficiary

Business references

Reference #

Name

Address

City

Province / State

Postal code / Zip Code

Country

Phone number and extension

Fax

Contact person

Email of contact person

I hereby declare that all information provided is exact and complete and I authorize Techni-Contact Canada to make a credit inquiry on my account.

Name of authorized person

Position

Date

How did you hear from us?

For more information, please call 1 866 320-9451 or write to .