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Online Membership Application / Profile Form
Please complete all required fields!
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:
(*)
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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:
(*)
Corporation
Partnership
Proprietorship
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:
(*)
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
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:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Please click on your primary bank branch province.
Postal Code:
Invalid Input
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:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Please click on your primary bank branch province.
Postal Code:
Invalid Input
Phone:
Please enter phone number (xxx-xxx-xxxx)
Fax:
Please enter fax number (xxx-xxx-xxxx)
Branch Manager:
Invalid Input
Name of Store:
Invalid Input
Location:
Invalid Input
Address:
Invalid Input
City:
Invalid Input
Province:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Please click on your primary bank branch province.
Postal Code:
Invalid Input
Phone:
Please enter phone number (xxx-xxx-xxxx)
Fax:
Please enter fax number (xxx-xxx-xxxx)
Branch Manager:
Invalid Input
Name of Store:
Invalid Input
Location:
Invalid Input
Address:
Invalid Input
City:
Invalid Input
Province:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Please click on your primary bank branch province.
Postal Code:
Invalid Input
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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