Ecotrend Ecologics | Professional Account Application Form
Legal Business Name: *
Billing Address: *
Shipping Address: *
Same as Billing Address
Contact: *
Type of Practice: *
PST #: *(If you don't have PST# then write 'N/A')

Please note: PST is required in BC, SK, and MB. Without PST # you will be charged PST on applicable product. PST # must be provided at time of application. Ecotrend will not issue credit for PST on orders processed prior to PST # being provided.

Credit Card Details :

Card type *

Credit Card Number :*

Expiry Date :*

Month : / Year :
*I acknowledge I have read the "Third Party Online Retailer Policy"
Name of Authorized Person: *
Position: *
Date: *
Professional Certification: *
The above information is herewith submitted for the purpose of opening an account with Ecotrend Ecologics Ltd. and I do hereby certify this information to be true. Further I verify that I am a principal or officer of the company or am authorized to legally bind the company. I certify that the business identified herewith is a retail or professional business and is purchasing product for resale only. All applicable sales taxes will be collected by the business at the time of sale to a customer. All product remains the property of Ecotrend Ecologics Ltd. until paid in full. I have read and agreed to the terms outlined above.
THE FIRST ORDER receives a minimum 5% discount and free ground shipping. The first two orders MUST be prepaid. Please contact our accounting department for payment methods.