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email@example.com 6165 Kennedy Road MISSISSAUGA, ONTARIO L5T 2S8 Email: firstname.lastname@example.org www.xcelsoftwaresource.com TEL:(905)564-9235 FAX:(905)564-3066 **PLEASE FAX OR EMAIL** NEW ACCOUNT REGISTRATION Xcel Software Source Corporation will require the following Provincial Forms and a credit card to activate your Canadian Account, For USA clients please provide Xcel with your Federal Tax ID Number: Number: Province CANADA Provincial Requirements Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Ontario P.E.I. Quebec Saskatchewan State All Business License / Certificate of Incorporation / Provincial Registration Provincial Sales Tax Exemption Certificate Certificate of Registration Certificate of Registration Certificate of Registration Certificate of Registration Vendor Permit and Blanket Exemption Certificate Form Certificate of Registration TVQ (Taxe de vente du Quebec) Ministry of Finance License USA Requirements Federal Tax ID number Please fill out form as clearly as possible. COMPANY INFORMATION Legal Name: Please Choose ONE of the Following. We are a: CORPORATION Company Address: Province: # of Years in Business: Gross Annual Sales: PARTNERSHIP City: Postal Code: Business Phone #: # of Employees: GST#: P.S.T. # / TVQ #: Business Fax #: # of Locations: SOLE-PROPRIETORSHIP Operating As: PREFERRED PAYMENT METHOD [ ] Credit Card ** **Please refer to page 3 and follow credit card instructions COMPANY PRINCIPALS Name: Home Address Name: Home Address Name: Home Address Title: Email Address: Title: Email Address: Title: Email Address: 3c5a3356-2df2-4ee0-86c3-c2fc8495ee95.doc Page 1 of 4 email@example.com 6165 Kennedy Road MISSISSAUGA, ONTARIO L5T 2S8 Email: firstname.lastname@example.org www.xcelsoftwaresource.com TEL:(905)564-9235 FAX:(905)564-3066 ACCOUNT INFORMATION BANK INFORMATION Please list all bank institutions used by your company: Bank #1: Bank #1 Contact Name: Bank #1 Account #: Bank #2: Bank #2 Contact Name: Bank #2 Account #: Bank #1 Address: Bank #1 Transit #: Bank #1 Tel #: ( ) Bank #2 Address: Bank #2 Transit #: Bank #1 Fax #: ( ) Bank #2 Tel #: Bank #2 Fax #: ( ) ( ) I HEREBY AUTHORIZE MY BANK (S) TO RELEASE ALL NECESSARY INFORMATION REGARDING ACCOUNT HISTORY. SIGNATURE xx TITLE: COMPANY CONTACTS Accounts Payable: Controller: Sales Manager: Purchasing Manager: NATURE OF BUSINESS Please select only one of the following that best describes your business. Are you part of a Buying Group Which Buying Group? Schools yes no Distributors Retailer/Etailer VAR/Consultants/Corporate Reseller Other(please describe) ______________________________ TRADE REFERENCES References must be able to quote a minimum one years trade experience. Company: Contact Name: Company: Contact Name: Company: Contact Name: Account #: Account #: Address: Tel #: ( ) Account #: Address: Tel #: ( ) City: Fax #: ( ) Address: Tel #: ( ) City: Fax #: ( ) Province: City: Fax #: ( ) Province: Province: I CERTIFY THAT ALL INFORMATION ON THESE FORMS ARE TRUE AND CORRECT. Date: ______________ Name (Print): _____________________ 3c5a3356-2df2-4ee0-86c3-c2fc8495ee95.doc Page 2 of 4 Signing P email@example.com 6165 Kennedy Road MISSISSAUGA, ONTARIO L5T 2S8 Email: firstname.lastname@example.org www.xcelsoftwaresource.com TEL:(905)564-9235 FAX:(905)564-3066 ACCOUNT INFORMATION Credit Card Authorization Form Please fill out the following form and fax back a legible photocopy of both sides of your credit card to Xcel Software Source Corporation. Please Print all information clearly Company Name: Phone Number: Fax Number: Canadian Credit card Visa MasterCard American Express USA Credit card Visa USA MasterCard USA American Express USA Card Number: Expiry Date: Name of Cardholder: Signature of Cardholder: Title of Cardholder: I authorize Xcel Software Source Corporation to use this Visa/MasterCard or American Express Card for the purchase of goods/services from Xcel Software Source Corporation. I guarantee payment to Visa/MasterCard or American Express for the purchase of goods/services authorized above in accordance with the terms and conditions stated on my cardholder agreement previously signed to the financial institution that has authorized my use of the credit card, used on these transactions. 3c5a3356-2df2-4ee0-86c3-c2fc8495ee95.doc Page 3 of 4 Ministry email@example.com of Revenue Retail Sales Tax Branch Ontario ONTARIO RETAIL SALES TAX PURCHASE EXEMPTION CERTIFICATE Blanket Business Name: ____Xc___________________________________________________________________ _____ Business Address: _________________________________________________________________________ _________________________________________________________________________ ___ Vendor Permit Number (if applicable): ______________________________________________________________ Nature of Business: ____________________________________________________________________________ ___ Under the provisions of the Retail Sales Tax Act, the above-named business claims exemption from tax on the following items of tangible personal property and on the following taxable services: _________________________________________________________________________________________ ___ _________________________________________________________________________________________ ___ _________________________________________________________________________________________ ___ _________________________________________________________________________________________ ___ _________________________________________________________________________________________ ___ __________________________________________ __ Signature of Authorized Person ____________________________________ Date ________________________________________ __ Name of Authorized Person IMPORTANT The person purchasing the tangible personal property or taxable service for which an exemption is claimed must complete this certificate and give it to the supplier. The supplier is to retain this form as provided by the regulations. This purchase exemption certificate is valid for four years for purchases of the above-listed items and services if, (a) the box beside the word “blanket” at the top of the form is checked; and (b) the purchase order refers to this purchase exemption certificate. Every person who makes a false statement on this certificate or misuses this certificate is liable on conviction, to a fine of not less than $ 500 and not more than $ 10,000 plus an amount of not more than double the amount of the tax that should have been declared to be collectable or payable or that was sought to be evaded, or to imprisonment for a term of not more than two years, or to both. 3c5a3356-2df2-4ee0-86c3-c2fc8495ee95.doc Page 4 of 4
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