Menu
Become a dealer
Contact us
Dealer Application
Y
Personal Information
First Name
Last Name
Phone Number
Email
Company Information
Company Name
Owner Name
Company Phone
Address
City
Country
- Select country -
Canada
United States
Province/State
- Select state -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal/Zip Code
Company Email
Website
Business Information
Business Type
Sole Proprietorship
Partnership
Corporation
Years in Business
# of Employees
- Select -
None
1 - 2
3 - 5
6 - 9
10 or more.
Business Registration Number
T.P.S. # (Quebec only)
T.V.Q. # (Quebec only)
Trade References
#1
#2
I hereby certify that the information in this form is correct. The information is for use by Distribupet Inc. I/We agree that all overdue accounts will be charged interest from the invoice date at the rate of 2% per month. There will be a $40 charge on any cheques returned.
I agree.
I disagree.
Submit
