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Home :: 12th Annual CHHMA Night at the Races : About the CHHMA : Affiliate Application : Agency Application

Agency Application


Qualification:
Firms, corporations or divisions of corporations such as agencies or importers who do not qualify under the criteria of manufacturers, but represent one or more manufacturing member and derive a significant portion of their income from the sale of hardware or housewares products in Canada.

Please read this before continuing with the online application:

This application will not be processed until your cheque for membership fees has been received by mail.
 
Click here to see the 2012 Agency Membership Fee Schedule.
 
Cheques are to be sent to:

Canadian Hardware & Housewares Manufacturers Association
1335 Morningside Ave., Suite 101
Scarborough, Ontario M1B 5M4


Directories
Product Source Guide
Customers Directory
Members Directory
Suppliers Service Providers
Page 1.

1. We/I (name of company) do hereby make application for agency membership in the Canadian Hardware and Housewares Manufacturers Association and agree to abide with the bylaws of the Association.
* required field

2. Is your company Canadian owned?
* required field
Yes
No

3. If not, where is your parent company located?

4. Which CHHMA members do you represent? (list up to three):
* required field

5. Number of employees:
(Answer must be a number)

6. What is your (geographical) territory?

7. What other lines do you represent?

Who are your principals?

8. Name:

9. Title:

10. Name:

11. Title:

12. Name:

13. Title:

Your voting representitive will be:

14. Name:
* required field

15. Title:
* required field

16. Email:
* required field
(Answer must be a validly formed email address)

Your alternative representitive will be:

17. Name:

18. Title:

19. Email:
(Answer must be a validly formed email address)

Company Information:

20. Full Company Name:
* required field

21. Address:
* required field

22. City:
* required field

23. Province:
* required field

24. Postal Code:
* required field

25. Phone:
* required field
(Answer must be a validly formed phone number e.g. (999) 555-1234 x12)

26. Fax:
* required field
(Answer must be a validly formed phone number e.g. (999) 555-1234 x12)

27. Company Email:
(Answer must be a validly formed email address)

28. Company Website:

29. Number of Branch Locations:
(Answer must be a number)

List Branch Locations:

Branch 1:

30. Address:

31. City:

32. Province:

33. Postal Code:

34. Phone:

35. Fax:

Key Personnel

36. Name:

37. Title:

38. Name:

39. Title:

40. Name:

41. Title:

Branch 2



42. Address:

43. City:

44. Province:

45. Postal Code:

46. Phone:
(Answer must be a validly formed phone number e.g. (999) 555-1234 x12)

47. Fax:
(Answer must be a validly formed phone number e.g. (999) 555-1234 x12)

Key Personnel

48. Name:

49. Title:

50. Name:

51. Title:

52. Name:

53. Title:

Payment Type:

54. Applications are not processed until dues are received. Please indicate payment option.
* required field
Cheque to Follow
Credit Card

Please provide contact information in order to obtain credit card details.

55. Full Name:

56. Phone Number:
(Answer must be a validly formed phone number e.g. (999) 555-1234 x12)

A copy of this form will be sent by email to the voting contact representative indicated.