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By establishing an account with Sansin, you gain access to our custom specification and maintenance programs for your Accoya projects and customers.

You can either print the PDF form and fax/mail it to Sansin, as indicated on the form. Or you can use the electronic form below.  Any problems? Contact us at admin@sansin.com.



I am interested in:

Becoming a full-line Sansin distributorProject-specific purchases
Representative's Name


Information submitted will be kept strictly confidential.

Business name *

Fax number

Telephone number *


City, Province, Postal Code

E-mail *

PST # (Canada Only)

Tax ID # (USA Only)

Please indicate your business structure:


If a corporation or a partnership:  Please complete

Name of owners or directors

Personal Address (street name)

City, Province & Postal Code


If sole proprietorship or individual, the following statement is required.

The applicant consent:  By clicking the box below, I hereby consent to a routine verification by the Sansin Corporation if necessary.

I consent

Applicant's name


Trade references:

Business name Contact Telephone number Email


Bank name


City, Province

Contact name


Account #


Expected credit requirements based on 30 day terms:

If amount exceeds $10,000 a copy of the financial statements may be required.  Available: YesNo

Certification statement:  In event this account becomes delinquent and is placed into the hands of a licensed collector or attorney for collection. By clicking the box below, I (we) agree to pay, in addition to the delinquent amounts and finance charges thereon, collection or attorney fees, including court costs, equal to 25% of the delinquent balance, or the maximum allowed under provincial/state law, whichever is less.  Undersigned is Owner and/or Director of above named company.

I consent Date



* required field