Registration – Canadian Distributor Inc.

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First Name *

Last Name *

Legal Business Name *

Company Name (Operating as Name) *

Company Address *

City *

Postal Code (A1A1A1 format) *

Phone Number *

Alternate Contact Number

Email Address *

Website

Choose a Username *

Choose a Password *

Confirm Password *

Comments/Notes (optional)Please let us know the name of the Rep who approached you or the customer who referred you to us

GST Exempt Letter / Status Card / Treaty Info (optional) If you have a GST exempt letter / Status Card / Treaty Info please upload it here.

Privacy Policy Agreement *We are committed to maintaining the accuracy, confidentiality, and security of your personally identifiable information (“Personal Information'). As part of this commitment, our privacy policy governs our actions as they relate to the collection, use and disclosure of Personal Information. Our privacy policy is based upon the values set by the Canadian Standards Association’s Model Code for the Protection of Personal Information and Canada’s Personal Information Protection and Electronic Documents Act.