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Administrative address
Company Name
*
Address
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City
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Province
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Alberta
Colombie-Britannique
Manitoba
Nouveau-Brunswick
Terre-Neuve et Labrador
Territoires du Nord-Ouest
Nouvelle-Écosse
Nunavut
Ontario
Île du Prince-Édouard
Québec
Saskatchewan
Yukon
Postal code
*
Phone
*
FAX
Is the delivery address different from the postal address?
*
Yes
No
Shipping address
Address
City
Province
Alberta
Colombie-Britannique
Manitoba
Nouveau-Brunswick
Terre-Neuve et Labrador
Territoires du Nord-Ouest
Nouvelle-Écosse
Nunavut
Ontario
Île du Prince-Édouard
Québec
Saskatchewan
Yukon
Postal code
Phone, if different
FAX, if different
Tailgate
Delivery to tailgate
Additional Information
Are you the company's owner ?
Yes
No
Owner's name
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What is your name ?
First name
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Last name
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Title
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Owner
Buyer
Responsible account payable
Other
Email
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Do you want to add another person?
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First name
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Last name
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Title
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Owner
Buyer
Responsible account payable
Other
Email
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Saut de section
In operation since:
Activity field
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Tire / mechanical workshop
Reseller
Dealer
Other
Number of doors
Please enter a number less than or equal to
9999
.
Brand
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Mandatory purchase order number
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Yes
No
Annual purchases planned
Comments
Legal agreement
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I agree that the terms of payment are net on the 10th of the following month.
Formulaire imprimable français
