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New Account Application


Please complete the following form in as much entirety as possible. We approve pricing categories based on the information provided. Please note that fields with a double asterisk (**) are required.


Billing Information

** Primary Contact: 
Name of Organization: 
Telephone: 
Facsimile: 
** E-mail: 
** Street Address: 
** City: 
** Province: 
Other Province/State: 
** Country: 
** Postal/Zip Code: 
   

Shipping Information
(only if different from above)

Attention: 
Location Name: 
Street Address: 
City: 
Province: 
Other Province/State: 
Country: 
Postal/Zip Code: 

Business Information

** Nature of Business: 
Others (Please Specify): 
** Est. Annual Purchases (CAD$): 
Name of Financial Institution: 
Address: 
Account #: 
Contact Name/Tel: 
Trade Reference #1 Name/Tel/Fax: 
Trade Reference #2 Name/Tel/Fax: 
Trade Reference #3 Name/Tel/Fax: 
 
How Did You Hear About Us: 
 

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