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British Columbia Pawnbrokers Association

20369-56th Ave Langley, B.C. V3A 6Y3

Phone: 604-534-8845 Fax: 604-534-1323

FILL IN ALL INFORMATION, PRINT AND FAX.


Name of Business:
Owner's Name (s):
Owner's Signature:
Address:
City:
Prov:
Postal code:
Number of Shops:
Telephone #:	Area Number
Fax #:	Area Number
E-Mail:
Sponsor:

Please Check The Boxes That Apply:

New Member
Renewal
Pawnbroker Member
Affiliate Member ( Additional Stores )
Associate Member ( supplier )
I am licensed / certified pawnbroker in my prov / state.
My License Number is:

Membership Dues:

$ 250.00 Pawnbroker or Associate Member
$ 100.00 Affiliate Member ( per additional store )

Amount Enclosed: $

Method of Payment:

Check Enclosed:
Visa: Number:
Mastercard: Number
     Name: ( as listed on card )
     Expiration Date:
     **You may phone your Visa or Mastercard Number to us @ 604-534-8845

Special Instructions or Additional Information:

PRINT OUT THIS PAGE AND FAX TO 604-534-1323.

CALL 604-534-8845 IF YOU HAVE ANY QUESTIONS.