6 September 2010
Brokerchips.com Subscription Form

Brokerchips.com is an online marketplace, enabling trade of electronic components stock and availability worldwide with pricing from independent and franchised distribution. Millions of semiconductors, both active and passive are traded each day.

Sell your Stock and Excess inventory online, with thousands of users using our system every day, this is the place to sell your components, just send an email of your stock, excess or availability to inv@Brokerchips.com.

Account Email Address(your email address)
Phone Number(your phone number)
Fax Number(your fax number)
I, (state your name)
From (state your company),

authorize Market Maker Systems Canada Corporation, to charge my credit card on a

 Monthly basis in advance for the amount of US$ 55.00 
 Quarterly basis in advance for the amount of US$ 150.00 ( 3 months = $50 a month )
 Yearly basis in advance for the amount of US$ 500.00 ( 12 months = $41.67 a month)

 for the subscription to the "Brokerchips.com" website.

This subscription remains valid until cancelled by written notice (letter or email). Cancellation notice must be received at least 30 days prior to expiration. Any amounts paid are non-refundable. Market Maker Systems Canada reserves the right to cancel any subscription at any time.
Credit Card Payments

Card type: Visa Discover MasterCard American Express

Card Number: Expiry date: 
Cardholder Name: CCV Number
Cardholder Address:
 
_____________________________________
Cardholder Signature / Contract Signature

*Please PRINT and FAX to (604) 608-3163
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