New Affiliate / Vendor Form

Any issues filling out the form? Please get in touch with us at contact@citypallets.ca

Fields marked with an asterisk (*) are mandatory.

Company Legal Name*

Company Trade Name*

Address*

Contact Person*

Authorized Contact Telephone Number*

Business Number*

Payment Term*

Is the business or corporation sales tax registrant?*

Tax Registration Number*

Method of Payment (If EFT, please complete Section B below)*

PLEASE ATTACH A COPY OF A VOID CHECK WHEN SUBMITTING THIS FORM USING THE UPLOAD DOCUMENT FEATURE IN SECTION C BELOW

Financial Institution

Financial Institution Address

Name on Bank Account:

Bank Code / Institution Number:

Branch / Transit Number:

Account Number:

Accounts Receivable Contact*

Phone Number*

Email Address*

Authorized Name*

Authorized Title*

Date*

Document Upload

We declare that the above information is true, correct and complete.

Company