Dealer application

Please provide the following information so that we may assess your application request.

We will use this information for the sole purpose of evaluating your application and will not share or disclose it to other parties.

Your contact information

Name

Phone number

Your business information

Business name

Address

City

Province

Postal code

Business phone number

GST number

PST number

Financial institution for the business

Name

Address

City

Province

Contact name

Contact phone number

Trade references

Reference 1

Name

Phone

Reference 2

Name

Phone

Reference 3

Name

Phone

By sending this form, you certify the above information to be true, and you authorize Brewers' Marine to receive and exchange all information necessary to establish your account.