Apply To Become an Atlantic Dealer

Dealer Application Form

If you would like to start the process of learning more about becoming an Atlantic Green Home Solutions Ltd. Dealer, please complete this online application form. We have safegaurds to protect the security and integrity of your information on this page. Submitting this form does not obligate you in any way, and it does not obligate Atlantic to approve any applications. All applications are carefully reviewed by the President. The follow-up to this application is a formal invitation to the office to discuss this opportunity further.

Please note that some fields are required. These fields are marked with a red *.

Contact Information

*Full Name:
*Email:
Street Address:
City and Province:
Postal Code:
*Phone:
Cell Phone:
Best Time to Call:

Background Information

Age:
Occupation:
Employed By:
How long employed at present occupation?
Spouse's Name:
Spouse's Employment:
Children:
Ages:
Have you ever been convicted of a crime for which you were charged?
If so, for what?
Do you currently own, or have you ever owned your own business?
If so, describe:
Have you ever failed in business?
If so, why?
Education:
Will you be able to devote the time that is needed for a new business?
If not, who do you have in mind to operate the business?
In what city are you considering establishing the business?
If accepted, how soon do you want to be in business?

Financial Information

Total Assets
Real Estate:
Auto:
Cash:
Bonds:
Stocks:
Other:
Total Liabilities
Mortgage:
Notes due to banks:
Notes due to others:
Auto Loan:
Other:
What is the current annual income for your household?
If you were to proceed with this business, would you have to finance any portion?
What source of financing do you have in mind?
Would you be interested in learning more about how Atlantic can help you aquire small business financing?

Atlantic Window & Door Systems Inc.

Apply To Become an Atlantic Dealer

Dealer Application Form

Total Assets

Total Liabilities