NEW CUSTOMER INFORMATION FORM

Disclaimer: Please note that Toronto Research Chemicals Inc., will not
ship or bill to residential addresses as our products are to be used for
Laboratory Research. Please provide a company email address, personal
emails such as Hotmail, Gmail are not acceptable

All new customers must complete this form in

its entirety and any missing fields may delay the FOR INTERNAL USE ONLY
process. MANDATORY SECTIONS IN GREEN
Customer Number:

General Information

What sector do you work for? Pharmaceutical Clinical: Therapeutic Cosmetics and
Please choose the Drug Monitoring Personal Care
Basic Life Science
relevant sector(s) Research Environmental Agbio
Diagnostics Food and Beverage Chemicals
Forensic Toxicology Performance Materials Academia
Clinical Toxicology Cannabis

What customer Distributor End User B2B

type are you?
If a division/subsidiary, name
of parent company:

Customer/Company Name

Address Line 1

Address Line 2

City/Town Country:

Province/State ZIP/Postal Code

Phone number:

Type of business:

Years in operation:

(if ‘Yes’, tax exemption form

Are you tax exempt? Yes No
must be attached)

Owner’s Names:

Page 1
 Public Private
Type of organization:
Partnership Corporation Individual

Country of
Tax Identification #:
Tax ID:

CR code (Applies
VAT# to China):

Orders & Invoicing Information

Orders Contact Name:

Orders Contact Email: Order Contact Phone:

Courier Account Type: Courier Account number:

Invoicing Contact Name:

Invoicing/Billing Address:
(if different from above)

City/Town: Country:

Province/State: ZIP/Postal Code:

Accounts Payable (AP)

AP Contact Phone:
Contact Name:

AP Contact Email:

Receive invoices by email Yes Other - Please specify

Invoice Email:

Collective Collective invoices are when one invoice is generated per

delivery for multiple customer order numbers. For example,
if item 1 from customer order# AA and item 2 from customer *In either case, it’s
order# BB are delivered on the same day, they will be on one possible to have
Do you want Collective invoice. multiple invoices for
a single customer
invoices or Normal order number if it’s
invoices*? Normal Normal invoices are when one invoice is generated per
delivery of a single TRC customer order number. For example, been delivered in
if item 1 from customer order# AA and item 2 from customer stages.
order# BB are delivered on the same day, they will be on
separate invoices.

What name/reference for your company will appear on Toronto Research Chemical Inc.’s bank statement for
electronic payments (e.g. EFT, WIRE, ACH)?

Page 2
 Shipping Address – If different from Invoicing/ Billing address

Customer/Company Name:

Address Line:

City/Town:

Province/State:

Country:

Phone: Email:

Courier Account Type: Courier Account number:

If you have multiple

purchase orders with TRC,
can TRC ship available items
from these varying orders
into a single shipment
where possible?
If the answer to this question is “NO”,
this indicates that only items belonging
Yes No to a single order will be on a shipment.
A shipment will not contain items from
multiple orders.

Do you accept partial

shipment of all available
items on your pending
order(s)? Yes No
(i.e. all in-stock items to be
shipped separately from
back-ordered items and/or
items requiring retesting)

Page 3
 Credit Information

Credit Limit Requested: $ USD CAD

Preferred Payment Method: EFT ACH Wire Credit card Other, Please specify

Bank Name:

Bank Address:

City/Town: Country:

Province/State: ZIP/Postal Code:

Bank Account Number: Account Type:

Bank Account Manager: Phone Number:

Email:

DUN & Bradstreet #:

Page 4
 Trade References

Company Name Address/Phone Contact Name Email

1.

2.

I hereby represent that I am authorized to submit this form on behalf of the customer named above, and that the
information provided in this form above is correct and warranted to be true for the purposes of obtaining credit.
Additionally, I consent to the receipt and provision of account and credit information from and to Credit Grantors,
Credit Bureaus, and Suppliers of Services.

Name of signing authority:

Title:

Phone: Email:

Signature:

Date:

Contact us
T: +1 (416) 665 - 9696
US & Canada Toll Free: 1-800-727-9240
F: info.trc@lgcgroup.com
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