Welcome to Puresource : Account Setup

Canadian Reg Presentation

Puresource is a national distributor servicing Canadian Health Food Retailers. If you are a Canadian retailer, and would like to set up an account with us, please complete the form below and click "submit". Our new account set up person will contact you to complete the application. Once completed, received by Puresource, approved and setup, the catalogue will be sent out to you. Thank you for your interest.

Legal Company Name
Legal Company Name
Operating Name (if different from above)
Company Address
City				Postal Code
Telephone				Fax
Province
Primary Contact
First Name				Last Name
E-Mail Address

Please Note: By clicking the "Submit" button, you agree that all the information completed above is true and correct.