Customer Information Sheet

Please sign-up for our services by completing the form below.
We will contact you to arrange for a key delivery.
Please keep your information current.

Fields marked in 'RED' are required.

First Name:
Last Name:
Residence Address:
City:
Province:	Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Postal Code:
Home Phone:	(please include Area Code)
Work Phone:	(please include Area Code)
Cell:	(please include Area Code)
E-mail:
Spouse (if applicable)
First Name:
Last Name:
Work Phone:	(please include Area Code)
Cell:	(please include Area Code)
Other:	(please include Area Code)
Cottage Info
Address:
Town:
Province:
Postal Code:
Phone:	(please include Area Code)
Other Contact:
Important Phone Numbers (Heating, Fuel Supplier, etc.)
Company Name & Phone: (please enter each Company name and Phone on a new line)
Other Important Information: