ON-LINE ACTIVATION CHARGE ACCOUNT

Please complete all three sections below. Within 24 hours, you will receive a confirmation of your approval by email, using the manner you selected below. Your confirmation will include your Customer # and Password, which you will need to use to log-in and place orders on www.e-sonic.com.

NOTE: This form is for existing credit accounts only. If you do not have a credit account with Electro Sonic, please download and complete the Credit Application Form first before applying the below form.

1. Please complete the address information below. This should be the address where you would prefer all future correspondence to be sent:

Request Date:	, , 2008
Customer Acct. No.:
Company Name:
Address 1:
Address 2:
City:
Prov/State:
Postal/Zip Code:
Country
Telephone:	- - ext.
Fax:	- -

2. Please fill out to receive your Confirmation. This will be sent to you once your Activation Form has been received and approved, and will include your login information to use for placing online orders.

Email:
Recipient Name :

3. Please signify your company's approval to activate your charge account for online shopping by providing names and titles of two representatives of your company, below:

Requested by:
Title:
Approved by :
Title:
Date:	, ,

If you do not have a credit account with Electro Sonic, please click here.