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Welcome to the Mills/VRCA Affinity Program!                                                   vrca_logo

 

 

Please complete the form below to join the Mills/VRCA affinity program. Tony Weller will contact you as soon as possible to begin the implementation process for your organization.

Company Name Department Name
Phone Number Fax Number
Address City
Province Postal Code
Accounts Payable Name
Purchasing Contact Name Purchasing Contact Email
Nature of Business # of Employees
How did you hear about Mills Office Productivity?

Would you like order online?
Shopper First Name Shopper Last Name
Shopper Email
Do you require more online shoppers?

Shipping Location (if different from above)

Ship to Customer Name Ship to Department Name:
Phone Number Fax Number
Cost Center # Address
City Province
Postal Code
Multiple Shipping Locations?

Payment Details

Payment Method
P.O Required?