Trade Professional Registration Form
All fields marked with an asterisk (*) must be be completed
Company Profile
Registered / Legal Name of Business
*
Company Structure:
Corporation
Partnership
Sole Proprietorship
Company Mailing Address
*
Street Address
Street Address Line 2
City
State
Postal Code
Province
*
Please Select
AB
BC
MB
NB
NL
NT
NS
NU
ON
PE
QC
SK
YT
Other
The property is:
owned
leased
rented
Primary Phone Number
*
Primary Fax Number
Primary E-mail
*
Copies of invoices will be sent to this address
Owners & Principal Officers
Owner 1
*
First Name
Last Name
Owner 1 Direct Phone Number
*
extension
This is a:
cell phone number
home phone number
company phone number
Owner 1 E-mail
*
Additional Owners (if applicable)
Owner 2
First Name
Last Name
Owner 2 Direct Phone Number
extension
This is a:
cell phone number
home phone number
company phone number
Owner 2 E-mail
Owner 3
First Name
Last Name
Owner 3 Direct Phone Number
extension
This is a:
cell phone number
home phone number
company phone number
Owner 3 E-mail
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Purchasing Contact
Purchasing Contact
*
First Name
Last Name
Phone Number
*
Email
Additional Authorized Purchasers (if applicable)
If more than 5 purchasers, please submit your list of names and contact info to ar@connon.ca
First & Last Name
Phone #
E-mail
1
2
3
4
5
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Additional Company Information
Company URL
Instagram handle
Facebook handle
Business HST # (if applicable)
Age of business
less than 1 year
1 to 5 years
6 to 9 years
10+ years
Please check all that apply to your business:
landscape construction
landscape maintenance
landscape architect / designer
home builder
farm
nursery / garden centre
florist
member of Landscape Ontario
Other
Please submit 2 of the following:
business card, master business licence, advertising material such as a brochure or flyer, photo of company vehicle/equipment/uniform, sample invoice
File Upload
*
Browse Files
Drag and drop files here
Choose a file
max file size of 10MB
Cancel
of
File Upload
*
Browse Files
Drag and drop files here
Choose a file
max file size of 10MB
Cancel
of
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Applicant Information
"Applicant" being the person completing this form
Name
*
First Name
Last Name
Applicant Title
*
Applicant E-mail
*
A copy of this form will be sent to above e-mail upon submission
How did you hear about us?
Search engine (Google, Bing, etc.)
Radio
Television
Newspaper/Online Newspaper
Billboard/Transit Bus
LinkedIn
Facebook
Instagram
YouTube
Referral from someone in the business
Referral from a customer
Landscape Ontario Congress
Other
To apply for a credit account, continue to the next page, otherwise, press 'submit'.
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Trade Professional Credit Application
Please complete this section only if you would like to request a charge account
Credit References
Credit references should be unsecured trade credit (ie. credit which is not collateralized by an asset) Where possible, please include email address to help expedite process
*
Company Name
Contact Name
A/R Phone #
A/R E-mail or Fax #
Reference 1
Reference 2
Reference 3
Bank Reference
Bank Reference
Bank Name
Account #
Contact Name
Phone #
E-mail
Bank Reference
Approximate credit limit required
*
ex) $5,000
Accounts Payable Contact
A/P Name
*
First Name
Last Name
A/P Phone Number
*
Extension Number
A/P Fax Number
A/P E-mail
*
Invoices and statements will be sent to this address
Signing Authority Name
*
First Name
Last Name
Title
*
Signing Authority Declaration
*
I/We hereby certify that the above information is true and complete, and authorize our bank and references to release any information necessary to assist in establishing a line of credit and agree to pay our account according to terms, and to pay all collection fees, reasonable attorney fees, court costs, and other expenses incurred by Connon Nurseries Inc. to obtain recovery of amounts due in the event of nonpayment.
Signature
*
Date
-
Year
-
Month
Day
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