Name of the contact person in the company
Email address of contact person
Quebec Business Number (NEQ)
Date of incorporation of the company
Total number of employees
Number of representatives
Number of skus current products
Number of specialty skus
Number of private import skus
Agency Member (voting)Affiliate Member (related business)
Moins de 5M$Entre 5M$ et 25M$Entre25M$ et 50M$Entre 50M$ et 100M$Entre 100M$ et 200M$Plus de 200M$
Name and title of person completing the application
I am applying for membership in A3 Quebec and agree to abide by its rules and code of ethics. I have read the membership fees applicable to my company and I agree to pay them by cheque to the order of A3 Quebec.
Acceptance of application: Any applicant who meets the above mentioned membership criteria and who complies with the A3 Quebec Code of Ethics and Bylaws (available upon request) will be accepted.