Farm Implements Act Program - Application for Dealer Registration

(Please Print or Type)

Name of Applicant: ___________________________________________________

Business Name: _____________________________________________________

Address of principal place of business serving Ontario: _______________________

___________________________________________________________________

City, Province: _______________________________________________________

County: ____________________________________________________________

Postal Code: ________________________________________________________

Telephone Number: ___________________________________________________

Fax Number: ________________________________________________________

E-mail Address: ______________________________________________________

Website Address: ____________________________________________________

____ Sole Proprietorship

____ Partnership

____ Corporation

Owner/General Manager: ______________________________________________

Telephone Number: ___________________________________________________

Are service facilities maintained by the dealership? Yes ____ No ____

Service Area___________ sq. feet____ sq. meters____

No. of Mechanics: Licenced:________ Apprentices:________ Distributor Trained:________ Other:________

Total No. of Shop Employees:________

Type of Equipment Sold (Required):

Primary Field Equipment ____

Tractors ____ Tillage ____ No-till ____ Planters ____ Sprayers ____

Manure Handling ____

Harvesting Equipment ____

Combines ____ Balers ____ Mowers _____ Hay Eqpt____ Forage Eqpt ____

Grain bins ____

Materials Handling Equipment ____

Loaders ____ Augers ____ Elevators ____ Conveyors ____ Wagons ____

Farmstead Equipment ____

Silo Unloaders ___ Feeding Eqpt ___ Ventilation Eqpt ___ Cleaning Eqpt ___

Milking Systems ___

General ____

Snowblowers ____

I, the undersigned, hereby apply for registration as a Farm Implements Retail Dealer in the Province of Ontario and declare that to the best of my knowledge the above information is current and true.

Signature: ___________________________________________________________

Name (Print): ________________________________________________________

Position: ____________________________________________________________

Date: _______________________________________________________________

Please attach:

1. Registration fee of $200 by cheque or money order in Canadian Funds, payable to the Minister of Finance.
2. A sample copy of the Retail Sales Agreement (see information sheet in package).
3. A list of all distributors represented.
4. A list of all makes (brands) of farm implements offered for sale.

Forward Application To:

Farm Implements Act Program
Ministry of Agriculture, Food and Rural Affairs
Environmental Management Branch
1 Stone Road West, 3SE
Guelph, ON N1G 4Y2

For Department Use Only

Registration Number: ___________________________________________________

Date Issued: __________________________________________________________

Fee: _________________________________________________________________

Renewal Date: _________________________________________________________

Remarks: _____________________________________________________________

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