NutriScription Account Signup Form by djh75337

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									                            NutriScription Account Signup Form

Contact Name

Retail or Consultancy Business Name

Client Type (Check one)           Retailer      Consultant        Grower

Mailing Address

Town                                                      Province (Check one)   ON      QC    NB

Postal Code                                                                      NS      PEI

Phone                                                    Cell

Primary Email address NutriScription reports to be sent to

2nd Email address NutriScription reports to be sent to

UAP Canada Representative

Signup Date

Preferred Lab (Check one)           A & L Labs (London, ON)          Agri-Foods (Guelph, ON)

Nutriscription user ID# (Office use only)

Please return completed forms to:

Colin Smith

Fax (519) 268-8013

Or clicking on “Submit” will send form to csmith@uap.ca


                       Submit

								
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