Account Opening Form
AgroFusion
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INTRODUCTION
Thank you for your interest in our products! We would be happy to serve you. To simplify the process of opening your account, please fill out and submit this form. We'll get back to you within 1-2 working days. Thanks!
The Pantry Essentials!
Company Name (referred as ''Applicant'') *
Legal Name *
Quebec Enterprise Number (NEQ) or NE# (Canada) or EIN#/Tax ID (USA) *
Address (Number) *
Street *
Unit #
City / Town *
Postal Code *
Province / State *
GST # *
QST / PST / HST # *
Date that business started *
Website
Legal type *
Name of Owner 1 *
Name of Owner 2 *
Purchaser Name *
Phone & Extension of Purchaser *
Email of Purchaser *
Accounts Payable Responsible *
Phone & Extension of Accounts Payable Responsible *
Email of Accounts Payable Responsible *
Estimated Monthly Purchases *
Credit Line Requested *
Current Suppliers of dry goods *
Where did you hear about AgroFusion? *
Delivery Address (if different)
Do you have a loading dock? *
Type of pallets used
Clear selection
Please let us know if you have specific delivery instructions (palletizing, appointments, etc.)
Name and contact info of your Warehouse Manager *
BANKING INFORMATION
Bank Name
Address of Bank
Bank Account Manager
Their contact information (Phone, extension, email)
Bank Account Number
TRADE REFERENCES
Supplier 1
Account Manager
Their phone number & extension
Their email address
Supplier 2
Account Manager
Phone & Extension
Email
Supplier 3
Account Manager
Phone & Extension
Email
TERMS & CONDITIONS
1. Minimum purchase value:

1.1 The minimum purchase value for delivery in Greater Montreal is 800.00$. (The minimum may vary depending on location.)

1.2 The minimum purchase value for a pickup at our facilities or for a delivery for which the Applicant pays the delivery fees is of 300.00$.

2. The first order must be paid upon delivery/pickup by certified check, bank transfer or cash.

3. The terms of payment will be determined after the credit approval.

4. No return or credit will be accepted without prior authorization by AgroFusion. AgroFusion does not do refunds, only credit notes.

5. All goods sold to the Applicant remain the property of AgroFusion until full payment has been received.

6. A 60$ administration fee will be charged to the Applicant in the event of an NSF check.

7. The Applicant agrees to reimburse all fees generated in recovering amounts due to AgroFusion.
TERMS & CONDITIONS *
Required
AGREEMENT
By signing and submitting this form, the Signee:

1. authorizes any bank, credit office, and investigative agency to disclose to AgroFusion the information concerning the morality, reputation and the financial responsibilities of the Applicant;

2. authorizes AgroFusion to collect any information required for the opening of the account from the organizations and companies stated in this document;

3. guarantees that all the information provided in this document is true;

(Your information will be held in strict confidence.)
Agreement *
Required
Authorized Representative of the Company (''Signee'') *
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