EmailMe Form - Vapeurs de l'Ouest - Manufacturer Application

Manufacturer Company Name *
Contact Email *
Manufacturer Web Site
Contact Phone *
### - ### - ####
Do you have lab results for your e-liquid? *
Yes
No
Are you a member of ECTA, the CVA, or another Vaping Association? *
ECTA
CVA
Other*
If Other*, please specify
What Nicotine levels do you provide? (eg. 0,3,6,9,12) *
What are you bottle sizes? (eg. 30,60,120) *
What VG/PG ratios do you offer? (eg. 70PG/30VG, 50PG/50VG, 70VG/30PG, 80VG/20PG) *
Do your labels comply with Canadian Labeling Requirements? (ie. bilingual labels) *
Yes
No
Do you have Liability Insurance? *
Yes
No
Please upload one or more pictures of one of your bottle labels in full.