Online Order System Application Form

Thank you for your interest in ordering Cansec products through our website. Please complete the following form.

Please note:

Only registered Cansec Dealers and Distributors may have an Online Order Account. Online Order Account applications from end users will be declined.
The following sections must be filled in by your company’s purchasing department.
The account will be created under the name of the person specified in the General Information section.
If you are not a Cansec reseller, give us a try - we promise to spoil you! For information, you can contact us at sales@cansec.com or just give us a call at +1 (877) 545-7755 (toll free).
Your account will be created within 2 to 4 business hours following application submission, and you will be e-mailed your username and password.

General Information

I am an Authorized Cansec Dealer/Distributor*

Date

Company Name*

Street Address*

City*

Province/State*

Postal/Zip Code*

Country*

First Name*

Last Name*

Phone*

Email*

Please choose