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Submit the following form to set up your Wholesale International Couriers account
Accounts are activated within 24hours
Name :
TItle :
Company :
Street Address :
City :
Province
:
Postal Code :
Phone
*
:
Fax
:
A/P contact
*
:
Email :
*
Please provide the following Bank Information:
Pay by check
Bank :
Branch :
Branch Mgr :
Phone :
Fax
:
Pay by credit card:
Card Type :
Card Number :
Name On Card :
Expiry Date :
CVV
:
Trade Reference 1
Company name :
Contact person name :
Last transaction amount :
Telephone No :