AURORA MARINE INDUSTRIES INC.
7015 Ordan Drive, #11, Mississauga, Ontario L5T 1Y2
Tel: (905) 564-4995 ... Fax: (905) 564-4956
Email: ami@auroramarine.com ... www.auroramarine.com
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NEW DEALER APPLICATION FORM
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Trade Name:
______________________________________________
Date:
_____________________________

Corporate Name:
______________________________________________
Phone:
_____________________________

Mailing Address:
______________________________________________
Fax:
_____________________________

Shipping Address:
______________________________________________
Email:
_____________________________

City:  _______________________   State/Province:  ____________________      Zip/Postal Code:  _____________________

Shipping instructions: _____________________________________________________________________________________


Please check one of the following:  

IF CORPORATION: ...........................

IF SOLE PROPRIETORSHIP: ...........

IF PARTNERSHIP: ............................


Corporation: [ ]       

President’s Name:

Principal’s Name:

1) Partner’s Name:

2) Partner’s Name:


Proprietorship: [ ]       Partnership: [ ]

_______________________________________________________

_______________________________________________________

_______________________________________________________

_______________________________________________________

Responsible Financial Person ....................................... :
_______________________________________________________

Length of time in Business under this name:  Since: _______________ Years: ________________ Months: _______________

Federal ID # or PST#: ___________________ State Tax # or GST #: ____________________ Limit Requested: $___________

Is Purchase Order Requested? Yes [ ] No [ ]      Type of Account Requested: Open [ ]      Charge: Visa [ ] Mastercard [ ]

Type of Business: Marina: [ ]       Dryland Marina: [ ]       Chandlery: [ ]       Other ______________________________________

Business Premises: Owned: [ ]       Rented: [ ]       Length of Lease: _________________________________________________

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