Wholesale Account Application - Canada
NAME OF BUSINESS & MAILING ADDRESS

Years in Business

Years as Current Business Owner

DELIVERY ADDRESS
FULL NAME OF OWNERS & PARTNERS
ACCOUNTS PAYABLE CONTACT
CONTACTS & EMAIL PREFERENCES

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Email Preferences

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Email Preferences

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Email Preferences

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Email Preferences
Choose Your Weekly Email Lists

You may update your preferences including being removed from these lists at any time by emailing your representative.

Canadian Wholesale Customers have a minimum order of $500 per order and an annual commitment of $5000.  A CRA# is also required.  US Wholesale Customers have a minimum order of $1000 per order and an annual commitment of $12000.  

I hereby represent that I am authorized to submit the application on behalf of the customer named above and that the information is warranted to be true.  

Authorized Signing Officer Signature

Download version available here

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ADDRESS

Address: 17250 80th Ave, Surrey, BC, Canada

Phone: 604-576-2088

Email:  info@burlake.com

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