Username*

Username*

Email*

Email*

Store Name*

Store Name*

https://moosemarket.ca/store/[your_store]

First Name*

First Name*

Last Name*

Last Name*

Primary Contact Number*

Primary Contact Number*

Position/Title*

Position/Title*

Address*

Address*

City/Town*

City/Town*

Province*

Province*

Postcode*

Postcode*

Country*

Country*

Company Name*

Company Name*

Company Website

Company Website

Corporate Income Tax Number

Corporate Income Tax Number

Product Info Link (if any)

Product Info Link (if any)

Please select one of the personal verification you wish to upload*

Please select one of the personal verification you wish to upload*Valid Passport (front page) Canadian Driving License (front and back)

Valid Passport (front page) or Canadian Driving License (front image)*

Valid Passport (front page) or Canadian Driving License (front image)*

Canadian Driving License (back image)

Canadian Driving License (back image)

I confirm that all products I sell on Moose market are either made in Canada, Product of Canada or prepared in Canada.I understand that Moose Market may do further due diligence to confirm this.*

I confirm that all products I sell on Moose market are either made in Canada, Product of Canada or prepared in Canada.I understand that Moose Market may do further due diligence to confirm this.*

Password*

Password*

Confirm Password*

Confirm Password*

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