Ownership Change

Store Information - Step 1 of 3

Ownership Change Date

Please provide ticket number or the previous retailer ID/account number.

Contact for Store

Store Contact First Name

First Name

Store Contact Last Name

Last Name

Type of Business

Store Name (Doing business as)

Company Legal Name

(Exactly as it appears on your business license)

Store Phone Number

Store Email Address

Confirm Email

Store Address

Store Street Address

Address Line (Please include suite or unit number if required)

Store City

City

Store Province

Province

Store Postal Code

Postal Code

HST/GST Number

Do you have a PST/QST Number? (For applicants in BC, SK, MB & QC)

Please provide your PST/QST Number

New Owner's Name

Owner First Name

First Name

Owner Last Name

Last Name

Owner's Mobile Phone Number

Owner's Email

Confirm Email

(Please note that this email will be used to sign the retailer agreement through Adobe Sign)

Owner's Home Address

Owner Street Address

Address Line

Owner City

City

Owner Province

Province

Owner Postal Code

Postal Code

Owner's Date of Birth

Contact for Store

Store Address

New Owner's Name

Owner's Home Address

Billing Address

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