Online Membership Application / Profile Form

Company Details

Legal Name:(*)

Please type your company's Legal Name.

Street Address:

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Mailing Address:(*)

Please type your business mailing address.

City:(*)

Please insert your city.

Province:(*)

Please click on your province.

Postal Code:(*)

Please insert your postal code.

E-mail:(*)

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Phone:(*)

Please enter phone number (xxx-xxx-xxxx)

Fax:

Please enter fax number (xxx-xxx-xxxx)

Business Type:(*)

CorporationPartnershipProprietorship

Please specify your business type.

Date of incorporation if applicable:

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Website:

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GST Registration Number:(*)

Please insert your GST number.

Provincial Sales Tax Number:

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Primary Bank:(*)

Please list your primary bank.

Address:(*)

Please type your primary bank branch address.

City:(*)

Please insert your primary bank branch city.

Province:(*)

Please click on your primary bank branch province.

Postal Code:(*)

Please insert your primary bank branch postal code.

Company Officer One:

Name:

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Title:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Company Officer Two:

Name:

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Title:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Company Officer Three:

Name:

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Title:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Primary Contact Persons:

Primary Contact Name:

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Email:

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Alternate Contact Name:

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Email:

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Accounts Payable Manager Name:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Invoicing Email Address:

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Store Branches:

Main Branch Shipping Address:

Name of Store:

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Location:

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Address:

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City:

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Province:

Please click on your primary bank branch province.

Postal Code:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Fax:

Please enter fax number (xxx-xxx-xxxx)

Branch Manager:

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Additional Shipping Locations (Directly owned branch stores):

Name of Store:

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Location:

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Address:

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City:

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Province:

Please click on your primary bank branch province.

Postal Code:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Fax:

Please enter fax number (xxx-xxx-xxxx)

Branch Manager:

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Name of Store:

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Location:

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Address:

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City:

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Province:

Please click on your primary bank branch province.

Postal Code:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Fax:

Please enter fax number (xxx-xxx-xxxx)

Branch Manager:

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Name of Store:

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Location:

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Address:

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City:

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Province:

Please click on your primary bank branch province.

Postal Code:

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Phone:

Please enter phone number (xxx-xxx-xxxx)

Fax:

Please enter fax number (xxx-xxx-xxxx)

Branch Manager:

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Final Details

Upon receipt of this application Canpro will provide the applicant a complete disclosure package for review. This package includes Canpro Financial statements and all other information required by the Security Commission, If i find this satisfactory, I agree to supply, under separate cover the most recent Corporation financial statement of my business.
(All information contained in the financial statement is strictly confidential, that no member of Canpro, including its officers or directors will have access to this information.)

I understand the payment terms, and find the terms of participation and payment terms satisfactory.

I Agree(*)

Yes

Please accept Terms of Agreement before submitting this form.

Security Code(*)

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