Referral Partner Application

Fill out the form below to apply. We will review your information and prepare a written referral agreement for your approval as required by NI 31-103.

Contact Information

First Name *

Last Name *

Email *

Phone *

Entity / Business Information

Entity / Business Name *

Entity Type *

Industry *

Website

Business Address

Street Address *

City *

Province / State *

Postal / ZIP Code *

Country *

Additional Information

Are you currently registered with a Canadian securities regulatory authority? *

YesNo

How did you hear about us? *

Anything else you would like us to know?

Acknowledgments

I understand that as a referral partner, I may only provide the contact information of potential investors to Goodland Wealth Inc. and must not provide advice, recommendations, or information about specific securities. *I confirm that I am not currently registered with a Canadian securities regulatory authority, OR if I am registered, I have disclosed my registration status and firm affiliation above. *I understand that a written referral agreement is required before any referrals may be made, and that referred contacts will receive written disclosure of the referral arrangement and compensation as required by Canadian securities regulations. *

By submitting this form, you consent to Goodland Wealth Inc. contacting you regarding the referral partner program. Your information will be kept confidential and used solely for the purpose of evaluating your application. See our Privacy Policy.