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? :