New Agent Application

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Page 1

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Primary Contact Information (Approved Signatory)

First Name

Last Name

Title

Primary Phone

Secondary Phone

FORM ID

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Secondary Contact Information (If Applicable)

First Name

Last Name

Title

Primary Phone

Secondary Phone

Agency Information

General

Company Name

Company Email

Company Phone

Company Fax

Company Website

Billing Info

Billing Country

GST/HST Number

Upload Business License File

You must upload a copy of your Business License to proceed with application

Billing Street

Billing City

Province (India)

Province (China)

State (Nigeria)

Province/Territory (Canada)

State (United States)

State/Province (Other)

Billing Zip/Postal Code

Shipping Info

Shipping Country

Shipping Street

Shipping City

Province (India)

Province (China)

State (Nigeria)

Province/Territory (Canada)

State (United States)

State/Province (Other)

Shipping Zip/Postal Code

Detail

Country of Registration

Recruiting Market

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Recruiting Market Province (India)

Recruiting Market Province (China)

Year Agency Established

YYYY

Year Started in Canadian Market

YYYY

Number of Employees

Number of Students Overseas Last Year

Number of Students Sent to Canadian Colleges Last Year

Page 3

References

Reference 1

Institution

Institution Phone

First Name

Last Name

City

Country

Reference 2

Institution

Institution Phone

First Name

Last Name

City

Country

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