To become approved as an authorized dealer, please complete this application and click on the Submit button below. To download and print a PDF Copy of our Dealer Profile form, click here. Please be sure to include Area Codes for all Phone and Fax numbers.

Vendor Company Information
Company Legal Name
Operating or Other Name
Address
City
Province / State
Postal / Zip Code
Phone Number
Fax Number
Contact Name
Contact Title
E-Mail Address
Website Address
G.S.T. / Federal Tax I.D. #
Number of Locations
Business Structure	Corporation Proprietorship Partnership Private Incorporation
Business Start Date
Yrs Under Current Owners

Vendor Equipment Details
Equipment Types Sold
Brands Represented
Price Range (Min to Max)
$ Amount of Average Sale
% Sold on Lease
Estimated Life of Equipment?
Approx Resale After 3 Yrs?
After 5 Years?
Do you provide repair service?
List Warranty Details
Do you sell used equipment?
Stationary or mobile equip?
Customer Types	Commerical Consumers Both

Manufacturer / Supplier References
Supplier 1
Contact Name
Phone Number
Fax Number
Supplier 2
Contact Name
Phone Number
Fax Number
Supplier 3
Contact Name
Phone Number
Fax Number

Invoice Payment / Bank Details
Acct/Rec Contact Name
Phone #
Fax #
Bank Name
Branch Name / Address
Account Number
Transit #
Phone Number
Fax Number

The undersigned certifies the above information to be true and correct. I/We hereby authorize Westport to investigate and verify the information as needed, in order to establish a business relationship where Westport will provide financial services to my/our customers.

If this form is being faxed, please sign and date on the line below and fax to (604) 681-1680 or 1 (800) 667-4426


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