New Customer Information Form
This is NOT a Credit Application
Please fill in the mandatory fields marked ( * )
Company Name:* Date:*
Address:* City:*
Prov./State:* Postal/Zip Code:*
Telephone Number:* Fax Number:*
PST or Federal ID #:* Owner's Name:*
E-Mail Address:* Is your business conducted from your residence? *
What type of business are you?* How long has your company been in business? *
Who are your present suppliers?* How did you find out about JERICO?*
FOR C.O.D. Shipments: for payment by regular cheque please provide following (provide this information if you wish to pay by regular company or personal cheque)
M/C or Visa #: Cardholder's Name:
Expiry date:
I hereby authorize JERICO Sportswear to charge my credit card for the full amount of any cheques returned NSF/Stop Payment plus $25.00 NSF charges per cheque without further consent from myself. My completion and submition of this form may be considered as your authorization for this purpose and to obtain and/or exchange personal information and/or credit reference with credit agencies towards establishing and verifying financial standing.
Payment Preference: Personal or Corporate Credit Card
Certified Cheque
Cheque with Credit Card Back Up
Shipping Preference: U.P.S.
Post
Pick Up
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