PAYMENT INFORMATION for agent

Complete the Form Below to Become Our Esteemed Brokerage Partner

PAYMENT INFORMATION

Personal or PREC Banking Information - Must provide VOID cheque for account(s) - you can use up to two (2) accounts. If you use two (2) accounts, please indicate the percentage.

Account #1

Bank/Institution No

Transit No

Account No.

Would you like your HST to be withheld?

Yes No

Would you like to hold back for income Tax?

Yes No

Date

Agent Signature: