Distributor Application Business Information Legal Business Name Mailing Address Shipping Address City Province/State Postal/ZIP Code Phone No. Fax No. GST PST Fed. ID# or SSN Courier No. Purchasing/Sales Contact Accounts Payable Contact Credit References Supplier 1 Name Email Phone Fax Address Supplier 2 Name Email Phone Fax Address Supplier 3 Name Email Phone Fax Address Bank Reference Name Address Phone Fax The above information is for purposes of obtaining credit and is warranted to be true. I/we hereby authorize the company to whom this application is made to investigate the references listed pertaining my/our credit and financial responsibilities. Authorize
