A-Plus Registry - Corporate Registry Form

______________________________________________________________________

* This information is Required and must be
Filled in Correctly to ensure response!

Date of Request:

Your File Number #

Name of Company -
Existing or Proposed
(for which services are required

Amount

Corporate Access Number - (if known)

Email Address:

Your Name

Address

City

Province

Postal Code

Telephone:

(Bus)

(Res)

(Fax)

Service to be:

Mailed Out

Mail Address

Picked Up

Fax Same Day

Fax #

Area Code Fax Number

Payment Options:
Please select which payment option you would like:

1) Visa (unsecure)

Card Number    Expiry (01/12)

Security Code:     Name of Card Holder

2) MasterCard (unsecure)

Card Number    Expiry (01/12)

Security Code:     Name of Card Holder

3) PayPal Invoice (secure)
- Payment of the invoice can be made by credit card or with your PayPal account

An Invoice will follw your order

4) Interac® Email Money Transfer
- Interac Email Money Transfers work without the need to know your recipient's banking information because the money is transferred by your financial institution to the recipient's financial institution, through online banking and the interac network.
- A security question and answer help to ensure that the money is deposited by the intended recipient.
- The Interac Email Money Transfer service relies on several security measures, such as encryption technology, confidential user IDs and passwords and the secure login process of online banking.

To Email money transfer to Aplus Registry, login in to your online banking, email money transfer to payment@aplusregistry.com. You will need to send in a separate email the password you used for the transfer to be completed.

Type of Service: Select one only!

Other (explain below)

Incorporation Profile Search

Trade Name Profile Search

Photocopies

Diazo Copies

Certified Copies

Special instructions for any of the above services:

CORPORATE REGISTRY FORM