Become a Dealer

General Information

Company Legal Name:

Contact Name and Position:

Purchasing Agent:

Mailing Address:

Shipping Address: (If different than above)

Telephone:

Fax:

Email:

Web Address:

Business Information

Date Established:

Company HST Number:

Number of years in business:

Type of Business:

What area does your business cover?

Name of Owners:

Partners (if Partnership):

Major Stock Holders (if Incorporated):

Do you operate in areas other than Canada?

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