Confirm Account CA

Confirm Account for Industry-related Products

Please fill this form.
Name*

First NameLast Name
Email*
example@example.com
Product(s)*
Select product(s)
Intended use*
Same as the primary activity of the business.
Business Name*
Business Document*
Please attach the company registration document. Provincial, State or Federal businesses are permitted. We also accept Health Canada licence holder and FDA registration number.
Please verify that you are human*
Should be Empty: