| |
| |
Director/Officer Information 1 |
| |
Last Name |
First Name |
Middle Name |
| |
|
|
|
| |
Suite No. |
Street No. |
| |
|
|
| |
Street Name |
| |
|
| |
City |
Province |
"Other" for U.S.A or European |
| |
|
|
|
| |
Country |
Postal Code |
| |
|
|
|
| |
Director Information |
| |
Resident Canadian (applies to directors only) |
Yes
No
|
| |
Date Elected
Date Ceased
|
| |
(FORMAT: YYYY/MM/DD)
(FORMAT: YYYY/MM/DD)
|
| |
Officer Information |
| |
|
Date Elected |
Date Ceased |
| |
President |
|
|
| |
Secretary |
|
|
| |
Treasurer |
|
|
| |
General Manager |
|
|
| |
Other |
(FORMAT: YYYY/MM/DD) |
(FORMAT: YYYY/MM/DD) |
| |
|
|
|
| |
|
Payment Information:
|
Your name and contact information:
|
|
Your Full Name * |
|
|
E-mail Address
* |
|
|
Telephone (w/ area code)
* |
|
|
Fax (w/ area code) |
|
|
Full Mailing Address
* |
|
How do you wish to receive your
Copies of Corporation Filings:
by
Registered Mail E-Mail Pick-up
|
| |
We're ready to perform the
Corporation Filing you have requested, we just need your credit card information. This is a secure transaction.
Once approved, we will process your request.
|
| |
If you're ready with your credit card information, we're ready to proceed.
Credit Card: Please check off which card you're using. :
Name as it appears on Card : *
Credit Card Number : *
Expiry Date on Card :*
Month
Year
|
|
| Client Consent
I
First Middle
Last
Name Initial
Name
hereby confirm that the information as provided is complete,
accurate and correctly reflects "Services" required. I have read,
understand and/or agree with the Terms of Service Agreement
and Cityfax Privacy Policy.
I do authorize the above order and the Cityfax charges to be processed on the
credit card, as provided.
Further, by pressing "Submit" button I/we consent to the collection, use
and disclosure of information; provided to Cityfax, for the sole purposes of
completing "Services Requested".
This could involve disclosure to various
Federal/Provincial authorities, responsible for administering programs and/or
data files.
|