Member Application

Fields with * are mandatory

Company Name ^*

Address ^*

City ^*

State / Province ^*

Zip Code / Postal Code ^*

Primary Telephone Number ^*

Secondary Telephone Number

Primary Fax Number

Secondary Fax Number

For invoicing purposes, please indicate if your billing address is different from the address displayed

Contact:

Mr.

Mrs

Ms ^*

Contact Title ^*

Name ^*

Email ^*

Mr.

Mrs

Ms ^*

Contact Title ^*

Name ^*

Email ^*

Nature of Business (i.e. manufacturer, importer ...): ^*

Brands

Fields with * are mandatory

Address ^*

City ^*

State / Province ^*

Zip Code / Postal Code ^*

Primary Telephone Number ^*

Primary Fax Number

Comment

Billing Contact

Mr.

Mrs

Ms

Name ^*

Email ^*

Fields with * are mandatory

Please list the sales category for which your company qualifies. This information will remain strictly confidential.

Based on our last fiscal year sales, our Company qualifies in the following category:

Canadian Sales Qualification

U.S.A Sales Qualification

I am aware that Canadian (ONLY) membership fees for S.I.C.A. are based on our volume of sales of sporting goods equipment in Canada.

Name (Authorised Party) ^*

Signature ^*

Title ^*

Date ^*

All applications are subject to approval by the Board of Directors.

Member Application

Identification

Billing Address

Credit Exchange Group Selection

Billing Information: