| Your name and contact information:
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| Your Firm Name (If Applicable) |
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| Your Full Name * |
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| E-mail Address * |
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| Telephone (w/ area code) * |
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| Fax (w/ area code)
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| Full Mailing Address * |
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| How do you wish
to receive your PPSA/PPSR
Search Results |
| by Email by Mail
by Fax Pick-up
|
| |
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Province to be Searched |
Prov:
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| Debtor Name as it appears on the Registration Document:
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| Nine Digit File
Number: |
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| Secured Party: |
| Company Name: |
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| Full Address: |
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Payment Information
We're ready to perform the
PPSA/PPSR
Discharge
you have requested,
we just need your credit card information. This is a secure transaction.
Once approved, we will process your request.
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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
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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.
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