New Dealer Application Form

Customer Application Form / Formulaire D'application Pour Nouveau Client

This application form is for Canadian / US Customers Only. If you are outside the US or Canada, please call us to open an account.

This form is on a secure page. All information sent from this page is encrypted.

Fields marked with an Asterix (*) must be filled in

*Company Name / Nom de la Compagnie

* Business Owner's Name / Nom du Propriétaire

* Business Address / Addresse de la Compagnie

* City / Ville

* Postal/Zip Code / Code Postal

* Province / State

Country / Pays

Phone1

Mobile Phone / Cellulaire

Fax

* Email / Courriel

Website / Site Web

GST/HST - TPS/TVH

QST - TVQ

What type of business do you have?

Dealership / Concessionnaire Repair Shop / Garage de Mécanique Retail Store / Détaillant E-Commerce

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