Product and Service Submission Form for Local Suppliers

• Original Submission
• Update (Please submit an updated form only if your information has changed since your original submission.)

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, electricity work)
  • Office furniture suppliers
  • Office equipment suppliers (e.g., photocopier)
  • Temporary help services
  • Janitorial services
  • Security suppliers (e.g., alarm systems, security agents 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
• Indigenous business?

  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:
• Area(s) of delivery of goods or services (select all applicable choices):

  • Alberta
  • British Columbia
  • Manitoba
  • New Brunswick
  • Newfoundland and Labrador
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ontario
  • Prince Edward Island
  • Quebec
  • Saskatchewan
  • Yukon
  •  Please add any required specifications:

D- Supplier Point of Contact

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