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Wholesale Application Form
To be considered for a wholesale account please complete all questions below.
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* Indicates required question
Before starting this application please make sure that you have created a customer account on westernvarieties.ca. This can be done by clicking the "sign in or create account" button in the top right hand corner of any westernvarieties.ca page.
What email address was used to create your account?
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Your answer
Contact Name
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Your answer
Mailing Address - Street Address
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Your answer
Mailing Address - City
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Your answer
Mailing Address - Province/State and Country
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Your answer
Mailing Address - Postal or Zip Code
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Your answer
Email
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Your answer
Business Name
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Your answer
Phone Number
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Your answer
Website
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Your answer
Do You Have A Storefront?
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Yes
No - Online Only
If you answered yes to the above question, please provide your storefront address including city, country and postal code.
Your answer
How Did You Hear About Us?
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Your answer
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