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)

Bank (optional)

Account number (optional)

Phone (optional)

Name (optional)

Full name

Address (optional)

Street Address Address Line 2 City Province Postal Code

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