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Status : Production
Business Identification
Legal Business Name
*
Trade Name
*
Business Structure
*
Sole Proprietorship
Corporation
General Partnership
Limited Liability Partnership
Limited Partnership
Limited Liability Company (LLC)
Joint Venture
Business Phone Number
*
Extension
Alternate Phone Number
Extension
Fax Number
Business Email
*
Business Number (BN)
*
GST/HST Number
*
Are you exempt from PST?
Yes
No
In Business Since
*
Number of Employees
*
Business Address
Unit Number
*
Street
*
City
*
Province
*
Select a province...
Quebec (QC)
Postal Code / ZIP
*
Mailing Address
(If different from business address)
Street
City
Province
Select a province...
Quebec (QC)
Postal Code / ZIP
Business Contact
A/P Contact Name
*
A/P Phone
*
Extension
A/P Fax
A/P Email
*
Purchase Order Required
*
Yes
No
Payment Option
*
Option 1: Cash on Delivery (COD)
Option 2: Term Credit Required:
ODP Certificate (Refrigerant Purchase)
Upload Certificate
License Number
License Holder Name
License Type
Business Owner(s)
Business Owner - One
First Name
*
Last Name
*
Title
*
Director
Officer
Partner
Email
*
Phone
*
Business Owner - Two
First Name
Last Name
Title
Director
Officer
Partner
Phone
References
Reference - ONE
Account Number
Reference Name
Street Address
Phone
Ext.
Email
Reference - TWO
Account Number
Reference Name
Street Address
Phone
Ext.
Email
Reference - THREE
Account Number
Reference Name
Street Address
Phone
Ext.
Email
Banking Information
Institution Name
Transit Number
Institution Number
Account Number
Street Address
City
State / Province
Postal / Zip Code
Country
Phone
Ext.
Email
Airtek/Gree Representative
Estimated Monthly Purchase
Line of Credit Required
Select...
Yes
No
Signature
*
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Confirm Signature
By signing these terms and conditions, you acknowledge and accept all the terms and conditions set forth herein. Please read the terms and conditions carefully before signing.
By checking this box and electronically signing, I, the Dealer Principal, confirm my authority to bind the business and agree on behalf of the Dealer to all terms in the
Airtek Dealer Agreement
and related policies.
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