Account opening | Entreprises Vidéo Service

Full name of the company or individual(Required)

Administrator's name(Required)

Phone(Required)

Billing address(Required)

Street Address Address Line 2 City Province Postal Code

Head office address(Required)

Street Address Address Line 2 City Province Postal Code

Phone(Required)

Fax

Email(Required)

Annual rental amount(Required)

$5,000 to $15,000

$15,000 to $30,000

Over $30,000

Order form(Required)

Yes

No

Specify

Person authorized to order(Required)

Full name

Accounts Payable Manager(Required)

Full name

Email(Required)

Do you have insurance for the rented equipment?(Required)

Yes

No

Expiry date

What is the value on your insurance policy for the rented equipment and not your civil liability?

Insurance policy number

Name of your insurer

Preuves d'identités : Veuillez svp nous faire parvenir une pièce d’identité avec photo et adresse (Permis de conduire recto et verso) et une autre preuve d’adresse avec votre nom (Copie de la section postale avec date d’une facture récente de Téléphone, Hydro-Qc ou autre)

Drop files here or

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 25 MB, Max. files: 4.