Product and Service Submission Form for Local Suppliers

A- Product/Service Information

• Product/Service:
• Current Elections Canada Field Area of Interest: (pick the most relevant)

  Property owners, landlords or realtors for potential polling places
  Property owners, landlords, or realtors for office space
  General contractors and labourers (ex. Temporary ramp installations)
  Office furniture suppliers
  Temporary help services
  Janitorial services
  Security suppliers
• Explain how your product relates to an Area of Interest or how it would contribute to improving the accessibility, reach, convenience or effectiveness of services to electors:
• Link(optional - product URL):

B- Polling Place or Office Space Information (only for property owners or landlords)

• Polling Place or Office Space Address:
  City:

  Province: --- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

  Postal code:
• Is the place accessible?

  Yes
• Please provide details about the accessibility of the place:

C- Supplier Information

• Company or Organization Name:
• If you are a qualified supplier under a Standing Offer or Supply Arrangement, please provide its number:
• Is your business recognized and verified as a social enterprise by Buy Social Canada?

  Yes
• Organization Size:

  Small (1-25 Employees)
  Medium (26-99 Employees)
  Large (100+ Employees)
• Corporate Address:
  City:

  Province: --- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

  Postal code:

D- Supplier Point of Contact

• First name:
• Last name:
• Title:
• Phone number:
• E-mail: