Annual Dealer’s License Application Company Name* Do you own/operate permanent grain facilities in Canada?* Have you applied for licensing with the Canadian Grain Commission?* Yes No If yes, what is the status of licensing If no, please provide reason Address* Street Address Address Line 2 Town/City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*FaxWebsite List company and contact information on APG website?* Yes No Contact for Producers Contact Name and Email for Check-Off Reports* Accounting Email* Officers of the Company* Please check off all that apply.* Broker Broker Organic Buyer Buyer Organic Buyer Pet Food Consumer Sales Exporter Exporter Organic Exporter Pet Food Processor Processor Organic Processor Pet Food Please indicate which commodities your company deals in.* Peas Peas Organic Beans Beans Organic Lentils Lentils Organic Chickpeas Chickpeas Organic Faba Beans Faba Beans Organic Soybeans Soybeans Organic Other Pulses Lupins Please list all varieties below.*Please list all Consumer Sizes and varieties below (if applicable)Do you sell pulses to Alberta or western Canadian food service or consumer markets?*YesNoIf yes, please provide contact information Do you have any authorized agents operating under your company?*YesNoPlease list Authorized Agents below (if applicable) Δ
