MEMBERSHIP APPLICATION FORM

 

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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.

   

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