Agency Agent Application

APPLICATION TO BECOME A William Academy’S AGENT-AGENCY

Please fill in the information below. ( required * )

William Academy respects your privacy.
We will not sell or trade the information that you enter into this form.

Application to become a William Academy’s Agent-Agency:

Company Name :*

Address :*

City:*

Province:*

Postcode:*

Your Country:*

Year Established:*

No of Staff:*

No of Offices:*

Person Incharge:*

Title :

Phone Number:*

Fax:

Email :*

Web*:

Contact Information In Canada:

Contact in Canada:

Title:

Address:

City:

Province:

Postcode:

Country:

Phone Number:

Fax:

Email :

What Canadian school boards or high schools do you currently represent? :

Number of students you sent to Canada during the past two years? :

Please list any memberships in industry-related associations or organizations: :

Is there any other information you would like to provide us about your company? :