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B2B ACCOUNT APPLICATION

Please complete this form completely to request opening a retailer account. Allow 8 to 15 minutes to complete the form depending on the number of Web Portal users.

BEFORE YOU START

Are you the authorized person to complete this request?

Yes

WARNING

It appears that you are not authorized to complete this form.

Please contact the person responsible for your company to complete this application.

AWESOME!

Please therefore complete all fields marked with an asterisk* so that your request is valid. We will be happy to process your application as soon as possible.

We encourage you to review the Terms and Conditions related to a retailer account by clicking the link below.

Terms and Conditions

_____________________________________________________________

Company Legal Name

Other commercial name

Yes

Other commercial name

Are you a franchisee?

Yes

Does your company have one or more known OEM banners (Ex.: New Holland, Case IH, AGCO, John Deere...)

Banners

Please list all OEM banners for which you have a franchise.

In business since

Number of employees

How many employees does your company have?

Do you use Purchase Orders

Yes

Do you use Purchase Orders

POs MANDATORY?

Yes

Are purchase orders MANDATORY to make purchases? Agri-Can makes every effort to respect the internal standards of its commercial clients.

Accounts Payable Manager

Phone Number

Extension

Billing Address

City / Town

Country

Province

State

Different shipping address

Yes

Shipping Contact Person

Phone Number

Extension

Delivery Address

City / Town

Country

Province

State

Agri-Can Showcase Program

By adopting Agri-Can^® as your supplier, you will obtain a prominent position so that your customers can find you more easily. With more than 120,000 unique visitors per month to our website*, customers will be able to obtain their parts directly from you.

*_{Data provided by Google Analytics}^®

Do you have a website

Yes

Does your business have a website?

Website Address

Enter the address of your website where we will refer customers.

We take care of your brand image!

Upload your company logo below, to integrate it into our website in your Business Profile and thus be well-represented and maintain your brand image. Please be assured that your information and logos will be used solely for promotional purposes for your benefit as part of its marketing programs. No information is shared and we work with the greatest respect for trademarks.

This is what a Company Profile looks like on our website.

Keep in mind that the Agri-Can website has a dark background. Paler logos with a transparent background stand out better. If you do not have such a logo, our graphic designers reserve the right to adapt the colors of your logo while respecting your brand image.

UPLOAD YOUR LOGO HERE

Company Logo

Opening hours

Monday

Closed

Same as previous day

Same

Opening

Closing

DEALERS WEB PORTAL

In order to comply with your internal purchasing standards, our state-of-the-art web portal offers 2 types of accounts:

Manager - Authorized to complete orders and approve, modify, or cancel the purchase orders of employees assigned to him/her. He/She can track his/her employees' orders, access invoices, make a return or reorder.

Employee - Authorized to view dealer prices and complete purchase orders. However, he/she must submit the order to his/her manager for authorization and finalize the order. He/She can only follow his/her own orders and consult the associated invoices.

IMPORTANT

Each person must have their own email address to access the web portal. Otherwise, you can use a generic email for your employees. However, you are responsible for the shared use of this access.

User 1

The first user below is automatically a manager

First Name - Purchasing Manager

Last Name - Purchasing Manager

Language

English

French

Phone Number

Extension

Add another user?

Yes

User 2

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

Add another user?

Yes

User 3

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

Add another user?

Yes

User 4

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

Add another user?

Yes

User 5

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

Add another user?

Yes

User 6

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

Add another user?

Yes

User 7

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

Add another user?

Yes

User 8

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

Add another user?

Yes

User 9

First Name

Last Name

Language

English

French

Phone Number

Extension

Employee or Manager

Employee

Manager

Full Name - Employee Manager

The manager must be previously listed in the users or be the purchasing manager.

If you would like to add other users, check the box below. We will contact you to activate additional accounts.

Add more users

Signature

Complete name of signatory

Phone Number

Extension

Position held in the company

I am authorized to represent the company mentioned above and to sign this agreement.

I am authorized

Read the Terms and Conditions

This link will open a new window on your screen containing the terms and conditions. Then return to this window to complete your request.

DO NOT CLOSE THIS WINDOW OTHERWISE, YOU WILL LOSE YOUR DATA IN THIS FORM.

I accept the Terms and Conditions

Was it easy to fill out this form?

1 star = Long and painful 5 stars = Simple and easy