1. General Info

Company Name*

Name*

Address*

City*

Postal Code*

Province*
Select a ProvinceBritish ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNova ScotiaNew BrunswickNewfoundland and LabradorPrince Edward IslandNorthwest TerritoriesYukonNunavut

Phone*

Fax

Email*

2. Sales Channel (choose all that apply)

Storefront(s) (number of stores)

Number of Employees

Years in Business

Internet

3. Your Primary Customers/Markets (choose all that apply)

Campers/Hikers
Backpacking
Climbing
Kayaking/Rafting
Fishing
Law Enforcement
Hunting
Paintball
Auto Mechanics
Aircraft Mechanics
Watercraft Operators/Mechanics
Paramedics
Search and Rescue
Firefighters
Military
Other (please specify)

4. Do you have a web site?

yesno

If yes, enter URL:

5. Other Flashlight Brands carried

List brands

Comments

Please type the validation characters listed in the box below. The letters are case sensitive so please type the letters exactly how they are displayed. Do not type spaces between the numbers and letters.*

* indicates Required Field