agents

Agency/Business Name*

Main Point of Contact Name*

Owner of Company Name

Complete Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone Number*

Email Address*

Enter Email Confirm Email

Website

Number of Years in Business*

Country (ies) City (ies) represented*

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Number of Staff*

What can you tell us about your market in general? What makes your market unique?*

Have you and or your staff been through any formal training (workshops/seminars/conferences) related to working as an agent?*

Please specify here*

Does your Agency represent other institutions/organizations in Canada?*

Please specify here*

Please list the services your company currently provides.*

Do you have any affiliations with regulatory bodies?*

Which ones and in which countries?*

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Regulatory body name	Country

Which of our services are you most intrested in?*

You can pick one or more services.

How did you hear about us?*

MERCAN AGENTS FORM