Cansec Dealer Application and Agreement Form

Thank you for your interest in becoming a Cansec authorized dealer. Please complete and submit the following application form to assist us in our evaluation of your company. All information received will be held in confidence.

Dealer Application
General Information
Business Type




Personnel
Owner/President
Sales Manager
Accounts Payable
Business Operations
Systems Installed
Payment
30-Day Terms
Bank References
  • Not required if payment will be by credit card
  • Include bank references for personal accounts if your business type is sole proprietorship or partnership.
Trade References

Not required if payment will be by credit card

Supplier 1
Supplier 2
Supplier 3