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LEGAL COMPANY NAME:__________________________________________________________________ AFFILIATED COMPANIES IF ANY:___________________________________________________________ ADDRESS:_____________________________________CITY:________________PROVINCE:____________ POSTAL CODE:____________TELEPHONE NO.:(___)________________FAX NO.:(___)_______________ E-MAIL ADDRESS:____________________________ TYPE OF BUSINESS:_____________________________________ DATE ESTABLISHED:_______________ No. OF EMPLOYEES:_____________ ESTIMATED MONTHLY REQUIREMENTS $:_______________________ PST#:__________________________ PROPRIETORSHIP:_____________________________PARTNERSHIP:_______________________________ INCORPORATED:__________________________________ BANK REFERENCE:________________________________ BRANCH ADDRESS:_________________________________BANK ACCOUNT #:_________________________
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