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Dealer Request Form

If you are interested in becoming a dealer for Maritime Marine Supply, please complete the following form.

E-Mail*

Company Name*

First Name*

Last Name*

Company Address*

City*

Province / State*

Postal Code / Zip Code*

Country*

Phone*

Website

Type of Business*

eg. Marine, Automotive, Boat Builder, etc.

Purchaser Name*

Owner Name*

Accounts Payable Name

Language Preference*

Additional Information

Credit Reference 1*

Please provide company name, contact, phone number and email if applicable.

Credit Reference 2*

Please provide company name, contact, phone number and email if applicable.

Credit Reference 3*

Please provide company name, contact, phone number and email if applicable.

Contact Us

info@mmsupply.ca

26 Fourth St.,
Charlottetown,
PE, C1E 2B3
T: 902.566.1220
F: 902.368.3660
209 Terra Cotta Dr.,
New Glasgow,
NS, B2H 6A8
T: 902.928.1900
F: 902.928.1905

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