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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 Number
*
QST 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: 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
*
Select a title...
Director
Officer
Partner
Email
*
Phone
*
Business Owner - Two
First Name
Last Name
Title
Select a title...
Director
Officer
Partner
Phone
References
Reference - ONE
Account Number
Supplier's Name
Street Address
Supplier's Phone Number
Supplier's Phone Ext.
Supplier's Email
Contact Person's Name
Contact Person's Phone Number
Contact Person's Phone Ext.
Reference - TWO
Account Number
Supplier's Name
Street Address
Supplier's Phone Number
Supplier's Phone Ext.
Supplier's Email
Contact Person's Name
Contact Person's Phone Number
Contact Person's Phone Ext.
Reference - THREE
Account Number
Supplier's Name
Street Address
Supplier's Phone Number
Supplier's Phone Ext.
Supplier's Email
Contact Person's Name
Contact Person's Phone Number
Contact Person's Phone Ext.
Banking Information
Institution Name
Transit Number
Institution Number
Account Number
Street Address
City
State / Province
Postal / Zip Code
Country
Bank's Phone
Bank's Phone Ext.
Bank's Email
Account Manager Name
Account Manager Phone
Account Manager 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
Terms and Conditions
and related policies on AirtekShop.com.
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