New Account Form

Xcel Software Source
6165 Kennedy Road
Mississauga, Ontario, L5T2S8
www.xcelsoftwaresource.com

Phone: (905)-564-XCEL (9235)
Sales: EXT 290
Fax: (905)-564-3066
Toll Free: 1-877-612-8030
Email: sales@xcel.on.ca

Step 1: Please complete this form and click Submit to get a printer friendly page
Step 2: Print the page
Step 3: Please Fax or Email along with any applicable Tax Exemption forms to:

Xcel Customer Service Department
FAX # (905) 564-3066
Email: customerservice@xcel.on.ca

* Indicates a mandatory field.

Company Information
Legal Name
Trade Name
Street Address City
Province/State Postal Code/Zip Country
Is this a Residence Yes No
Phone PST/TVQ#
Fax Federal ID/GST/HST#
Website Address
Contact Information
Buying Contact * Accounts Payable Contact
Phone Phone
Email * Email
Legal Structure (check all that apply)
Corporation Sole Proprietor Other
 
Partnership Non-Profit
In Business Since # of Employees Gross Annual Sales
Billing Information Same as Above Shipping Information Same as Above
Address Address
City City
Province/State Province/State
Postal /Zip Postal /Zip
Country Country
Bank Information
Bank Name Bank Acct#
Bank Address City/Province/ Postal code
Bank Contact Bank Phone
Trade References
Company A/R Contact Province/State Phone# Fax#
1.
2.
3.
Payment Method
Credit Card
(Fill out Credit Authorization Form		 COD
(Attach Voided Cheque)		 Wire Other
 
Signature & Authorization
The signature below represents and warrants that (a) the party signing below is an authorized representative of the company; and (b) that the information provided herein is a complete and accurate representation of the company's information as of the date hereof. Any misrepresentation or fraudulent information provided will be the basis for default under this agreement. By signing this form, I expressly authorize Xcel Software Source to contact the above references to determine credit worthiness.
Signature Date
Print Name Title
 
XCEL INTERNAL USE ONLY
Customer#   Sales Executive  
 

Credit Card Information
VISA MASTER CARD AMEX
Credit Card No. Expiry Date
Name on Card Signature
I am the authorized signer on the above card and hereby give permission to bill my credit card for purchase of goods from Xcel Software Source.
Signature Date
Print Name Title