Brassex Inc.

Billing Address

Address (Line 1) *

Address (Line 2)

City *

Province *

Postal Code *

Country *

Telephone *

Fax

Contact Name *

Email *

GST / HST Account # *

Shipping Address

Shipping Info same as of Billing's

We do not ship to residential addresses

Company Name *

Address (Line 1) *

Address (Line 2)

City *

Province *

Postal Code *

Country *

Telephone *

Fax

Contact Name *

Email *

Always ship to unless otherwise instructed

Preferred Method Of Payment

Credit Card

Certified Cheque

Wire Transfer

Contacts

(If different than Billing's)

Buyer

Owner / President

Order Confirmations

Catalogue Updates

Shipping Notifications

Invoice Notification

* I have read, understand and agree to the above policies and procedures of Brassex Inc.. Please also visit our General Info on our website at www.brassexinc.com for full details and updates on our policies and procedures, and our company offerings.

Applicant's Name *

Forms

New Account Application

General Information

Buying Group Affiliate