Canoe Member Finance Form - Canoe Procurement Group of Canada

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We’re excited you’re here!

Please fill out the form below with the most accurate and up to date information to help us better serve you. By filling this you, you acknowledge that you are authorized to sign …….on behalf of your organization.

Province/Territory

Organization Information

Organization Name

Type of Organization

Primary Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Information

Primary Contact – Name

Procurement Contact – Name

Primary Contact – Email

Procurement Contact – Email

Primary Contact – Phone Number

Procurement Contact – Phone

Billing Information

Accounts Payable Name

– Position Billing

Accounts Payable Phone

Accounts Payable Email to Receive Invoices

Up to three emails allowed

Primary Shipping Information

Please list your primary and additional shipping addresses below. Please provide physical addresses. Orders cannot be shipped to PO boxes.

Shipping Addresses

Agreements and Acknowledgements

Should include payment terms are net 30

Agreed

Authorized Signature

Clear Signature

Printed Name of Authorized Individual

Position / Title

We are committed to protecting and respecting your privacy. We will only use your personal information to administer your account and provide the services requested.

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Organization Information

Contact Information

Billing Information

Primary Shipping Information

Agreements and Acknowledgements

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