Welcome to CustomCare online registration. Please complete the following form providing your company details for the CustomCare Plan.
NOTE: The address you enter below must match your credit card otherwise your credit card will be declined. If you have difficulties please do not hesitate to call us and tell us about this problem.
indicates mandatory field
Company Legal Name
Company Short Name
MAILING ADDRESS
Street Address
City
Province
British Columbia Alberta Saskatchewan Manitoba Ontario New Brunswick Nova Scotia PEI Newfoundland Yukon NWT/Nunavut
Postal Code
[T2T2T2]
Phone Number
( ) * No hyphen
Fax Number
Email Address
Preferred Method of Contact
Email Phone Fax * Pick One
Contact Person (first, last)
How did you hear about us?
If an advisor/client, who?
* Please give full name or company
Saw a voucher? Enter #
# of Employees
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 * 1 min (i.e. business owner)
Type of Business
Incorporated/Ltd. Sole Proprietor
Additional Information
