Unit 14-15 Sun Pac Blvd, Brampton ON L6S 0E8, Canada

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    A) Company Information Address

    Legal Company Name:

    DBA (if different from above):

    Registered Business Address:

    City:

    Province:

    Postal Code:

    Phone:

    Fax:

    GST/HST #:

    PST/QST #:

    WSIB/WCB Coverage:
    YesNo

    WSIB/WCB Account #:

    B) Company Information

    Type of Business:CorporationPartnershipProprietorship

    Name of Person Responsible for Accounts Receivable:

    Phone:

    Fax:

    Email:

    Contact Information

    Primary Contact:

    Phone:

    Direct:

    Email:

    Secondary Contact:

    Phone:

    Direct:

    Email:

    Type of Services Offered

    Does your company provide Structured Cabling/Wireless services?YesNo

    Does your company provide Fiber Optic Cabling services?YesNo

    Does your company provide FTTH/FTTS, Fiber Splicing services?YesNo

    Does your company provide AV/Projector services?YesNo

    Does your company provide Digital/VoIP Telephony services?YesNo

    Does your company provide CCTV services?YesNo

    Does your company provide Electrical services (Electrical licence required)?YesNo