DistributorApplication

Personal Information

First Name

Last Name

Job Title

In what language would you like to receive communications?

English

French

I want to receive Ak-West Inc. Emails

Yes

Business Information

Company Name

Address

City

Province

Postal Code

Phone Number

Extension

Fax

Website (Leave blank if your business does not have one)

Type of Business

Business Registration Number (optional)

Do you require a P.O. number?

Yes

Invoicing Address

Please select your invoicing address.

Same as Company Address

Different Address

Shipping Address

Please select your shipping address.

Same as Company Address

Same as Invoicing Address

Different Address

Accounts Payable Contact Information

In order to serve you, please provide your Accounts Payable contact information:

First Name

Last Name

Phone Number

Extension

Invoices

Please choose a preferred method to receive invoices:

Fax

Supplier Information

Please provide a minimum of 3 suppliers.

Company 1

Company Name

Address

City

Province

Postal Code

Phone Number

Extension

Fax

Company 2

Company Name

Address

City

Province

Postal Code

Phone Number

Extension

Fax

Company 3

Company Name

Address

City

Province

Postal Code

Phone Number

Extension

Fax

Company 4

Company Name

Address

City

Province

Postal Code

Phone Number

Extension

Fax

Additional Information

Years in Business

Number of Employees

Primary Business

Territory Covered

Agreement of Terms and Conditions

Please read our Terms and Conditions (page will open in a new tab)

By reading and accepting these terms and conditions, the Client authorizes Ak-West Inc., his employees, officers and/or representatives, to obtain any information about the company.

I accept the terms of this agreement

Name of authorized applicant

Title of authorized applicant

Becoming a Distributor with Ak-West Inc.

Personal Information

Business Information

Invoicing Address

Shipping Address

Accounts Payable Contact Information

In order to serve you, please provide your Accounts Payable contact information:

Invoices

Supplier Information

Please provide a minimum of 3 suppliers.

Company 1

Company 2

Company 3

Company 4

Additional Information

Agreement of Terms and Conditions