Sales Request Form - Upper Canada Organic Products

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Product Lines

	Insect Control
	Weed Control
	Fertilizers
	Tools
	Natural Body Care

	Sales Request Form

	Sales Request Form

Are you interested in selling our products in your business? Please complete the form below to get started!

As a convenience, we now accept Visa and Mastercard on bulk orders.

Contact Information:

First Name:

Last Name:

Your E-mail:

Your Position:

Your Company:

Address 1:

Address 2:
(optional)

Town or City:

State or Province:

Zip or Postal Code:

Country:

Area Code & Telephone:

Fax:

How did you
hear about us?:

How would you best describe your business (Check all that apply):

Retailer
Wholesaler
Distributor

Other

Please indicate the products that you are interested in selling (Check all that apply):

Insect Control Products
Weed Control Products
Fertilizers
Tools
Natural Body Care Products

Other

Questions and/or Comments:

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