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2015 MEMBERSHIP APPLICATION
CHECK (√) ON OF THE FOLLOWING CATEGORIES:
____
VOTING MEMBER
Anyone incorporated and active in the wine beers and spirits industry, for at least two years as a sole
representative in Quebec for distillers products, vintners or brewers in Canada or abroad, having a place of
business in Quebec and supplying products to the Société des alcools du Québec or any other agency in lieu
thereof, generating a minimum level of sales as determined by the Board of Directors.
2015 CONTRIBUTION
CHECK (√)
THE APPROPRIATE BOX
□ 5 M$ or more (retail) at the SAQ
2 118, 66 $
(1 842, 71 $ per year + GST and QST)
*** Offer for new voting members - 50 % discount for the first year
1 059, 33 $
(921.35 $ + GST and QST for the first year)
□ Less than 5 M$ (retail) at the SAQ
1 412, 46 $
(1 228, 49 $ per year + GST and QST)
*** Offer for new voting members - 50 % discount for the first year
706, 23 $
(614, 25 $ + GST and QST for the first year)
____
CORRESPONDING MEMBER
Any person, individual or company in a related or complementary field to the representation of wine
products, spirits or beer, but do not qualify as a voting member.
2015 CONTRIBUTION
APPLICANT :
1 085, 11 $
(943, 78 $ per year + GST and QST)
__________________________________________________________________________________
(BUSINESS
NAME,
AGENCY,
TRADE
DELEGATION,
CORPORATION,
ETC.)
ADDRESS:
____________________________________________________________________________________
STREET, BOULEVARD, AVENUE, INCLUDING OFFICE NUMBER
CITY :
__________________________________
POSTAL CODE :
PHONE :
_______________________________
FAX :
EMAIL :
__________________________________________________________________________________
WEBSITE :
____________________________________________________________________________________
1ST REPRESENTATIVE : _______________________________________
1ST REPRESENTATIVE’S EMAIL:
______________________
_____________________
TITLE : _________________________
_______________________________________________________________
2ND REPRESENTATIVE:
_______________________________________
2ND REPRESENTATIVE’S EMAIL:
_____________________________________________________________
QUEBEC BUSINESS NUMBER (QBN):
DATE OF CORPORATION:
MAIN ASSOCIATES
TITLE: _______________________
__________________________
__________________________
__________________________
NAME
___________________________
TITLE
__________________________
NAME
___________________________
TITLE
__________________________
NAME
___________________________
TITLE
NUMBER OF REGULAR EMPLOYEES (including management and/or owner)
REPRÉSENTATIVES :
_______
OFFICE STAFF :
__________
SAQ PRODUCT LISTING
Number of regular products
______
Number of specialty products
______
Number of private imports products
______
I, the undersigned requests the admission of our agency as a member of the Quebec Association of wines, beers and
spirits agencies (AQAVBS) and agree to abide by its rules and its code of ethics.
REPRESENTATIVE ‘S SIGNATURE : __________________________________________________________
TITLE : __________________________________________
DATE : __________________________________________
Please submit your completed form and a check paying the membership fee to:
AQAVBS Inc., 905 avenue de Lorimier, Montréal, Québec, H2K 3V9
A company shall not be considered as long as it has not paid the membership fee.