CSSA - Application

CSSA Logo

With Chapters in:

Atlantic Canada
Québec
Ontario
Manitoba
Saskatchewan
Alberta
British Columbia

The Canadian Sanitation Supply Association
L’Association canadienne des fournisseurs de produits sanitaires
910 Dundas Street West
P.O. Box 10009, Whitby, ON L1P 1P7
Tel: 905-665-8001 • 866-684-8273
Fax: 905-430-6418
e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it • URL: www.cssa.com

MEMBERSHIP APPLICATION

Please complete all sections in detail and return to the CSSA
with payment in full

Company Name
Address
City

Province/State	Postal Code
Country
Phone	Fax
Company eMail
WebSite

Type of Business:
	Manufacturer	Manufacturer’s Agent
	Master Distributor	Contract Cleaner
	Distributor
Other

Products or Services

Delegate		Title
Delegate eMail

Alternate		Title
Alternate eMail

Chief Executive Officer of the Company

Number of Employees:		BC		Alberta		Saskatchewan		Manitoba
		Ontario		Québec		Atlantic		U.S.

Year the Company was Established
Language of Preference	English
	French

Annual Membership Dues:

	Full Membership: $400 plus 5% GST
	Supplementary Membership (Branch Office): $150 per branch plus 5% GST
	Multi-membership plan for $1000.00 per year (which includes 1 Full membership and up to 9 Supplementary memberships)

N.B. Membership fees cover the period January 1 to December 31. New members will receive a pro-rated invoice in the
next calendar year.
All membership applications are subject to approval by the Board of Directors of the CSSA.

Method of Payment:

By Enclosed Cheque	By Credit Card
	By VISA
	By MasterCard
	Credit Card Number:
	Exp. Date (MM/YY):

		This website is protected by an SSL Certificate.

GST Registration No: R100771401

= Required

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You can also download the Registration Form and then fax it to: 905-430-6418

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