Business Identification

Legal Business Name *

Trade Name *

Business Structure *

Business Phone Number *

Extension

Alternate Phone Number

Extension

Fax Number

Business Email *

Business Number (BN) *

GST/HST Number *

Are you exempt from PST?

Yes No

In Business Since *

Number of Employees *

Business Address

Unit Number

Street *

City *

Province*

Postal Code*

Mailing Address

(If different from business address)

Street

City

Province

Postal Code

Business Contact

A/P Contact Name *

A/P Phone *

Extension

A/P Fax

A/P Email *

Purchase Order Required *

Yes No

Payment Option *

Option 1: Cash on Delivery (COD) Option 2: Term Credit Required:

ODP Certificate (Refrigerant Purchase)

Upload Certificate

Licence Number

Licence Holder Name

Licence Type

Business Owner(s)

Business Owner - One

First Name *

Last Name *

Title *

Email *

Phone *

Business Owner - Two

First Name

Last Name

Title

Phone

References

Note: If applicants apply as COD, this section is not mandatory.

Reference - ONE

Account Number

Reference Name

Full Address

Phone

Ext.

Reference - TWO

Account Number

Reference Name

Full Address

Phone

Ext.

Reference - THREE

Account Number

Reference Name

Full Address

Phone

Ext.

Banking Information

Note: If applicants apply as COD, this section is not mandatory.

Institution Name

Transit Number

Institution Number

Account Number

Street Address

City

Province

Postal Code

Country

Phone

Ext.

Soreno Water Representative

Estimated Monthly Purchase

Line of Credit Required

Terms and Conditions

Signature *

BY CHECKING THIS BOX AND ELECTRONICALLY SIGNING, I, the Dealer Principal, confirm that I am applying to become a Soreno Water Dealer with full authority to bind the business, and I agree in both my personal capacity and on behalf of the Dealer to be bound by all terms, including the Soreno Water Dealer Agreement, applicable credit terms extended by Soreno Water, privacy policies, website terms and conditions, terms of use, and any related terms and policies published on Soreno Water’s website at www.SorenoWater.com. I acknowledge that I have read and understood all such terms and policies and consent to the collection, use, and retention of business and personal information for dealer onboarding, credit assessment, and ongoing commercial engagement. I further agree that any updated terms or policies published on Soreno Water’s website shall apply, and that continued participation in the Soreno Water Dealer Program constitutes acceptance of such changes. I understand that consent may be withdrawn by written notice to Soreno Water, but acknowledge that doing so may affect participation in the Soreno Water Dealer Program. *

Business Identification

Business Address

Mailing Address

Business Contact

Payment Option *

ODP Certificate (Refrigerant Purchase)

Business Owner(s)

Business Owner - One

Business Owner - Two

References

Reference - ONE

Reference - TWO

Reference - THREE

Banking Information

Terms and Conditions

Sign Below