Dealer Application VERSION EN FRANÇAIS ---> Dealer Card BILLING NAME AND ADDRESS ADDRESS CITY PROVINCE QuebecOntarioNew-BrunswickAlbertaSaskatchewanManitobaBritish ColombiaNova ScoiaNewfoundland POSTAL CODE TELEPHONE # IN BUSINESS SINCE COMPANY TYPE WEBSITE PRODUCTS INTERESTED IN NINE 1 METALDIRT-CAREALL FIRST CONTACT EMAIL TELEPHONE + EXT PURCHASING CONTACT EMAIL TELEPHONE + EXT ACCOUNTS PAYABLE EMAIL TELEPHONE + EXT DIRECT DEPOSIT PAYMENT METHOD CHECK PAYMENT METHOD ACCES D PAYMENT METHOD CREDIT CARD PAYMENT METHOD SHIPPIND NAME AND ADDRESS (leave blank if the same) SHIPPING ADDRESS (leave blank if the same) SHIPPING CITY SHIPPING PROVINCE QuebecOntarioNew-BrunswickAlbertaSaskatchewanManitobaBritish ColombiaNova ScoiaNewfoundland SHIPPING POSTAL CODE SHIPPING TELEPHONE # MESSAGE APPLICANT NAME FUNCTION Authorization The applicant acknowledges that he has the authority to open an account on behalf of the company. SUBMIT Address 136 1st Avenue Stoneham-et-Tewkesbury, QC, G3C 2N1 E-mail info@kappadistribution.com www.kappadistribution.com phone Contact Us (833) GO-KAPPA