print

Customer Request / Update Form

Fields marked with an asterisk (*) are required

New Customer:              Update Customer:               Number: WES

Customer Name *
Customer Address
Street (line 1)
Street (line 2)
Street (line 3)
City Province/State
Country Postal Code
Phone Number (ext) Fax  
Currency Code CAD     USD
Note:  Foreign Countries should use USD (preferred) or CAD

Customer Shipping Address (if different from above)
Street (line 1)
Street (line 2)
Street (line 3)
City     Province/State:
Country     Postal Code:

 

Contact/Attention To
Name: Title:
Phone Number: (ext) Fax Number:
E-mail Address:
Preferred Method Call: Call Fax: E-mail:


Additional Information:



Requester Name: *
Requester Phone *
Requestor Fax *
Requester Email Address *

 

Questions and/or comments should be emailed to:
Accounts Receivable Office