Step 1 | New Agent Application

NEW AGENT APPLICATION

Complete all required fields.

*Company Name

*Is your Company registered or incorporated?

Yes

Your company must be registered or incorporated to submit the application.

Please provide proof that shows your company is registered or incorporated.

Drop files here or click to upload. Make sure the file is a .jpg, .png or .pdf file.

*Has your company has successfully completed Fanshawe College’s training modules?

Yes

Your company must complete Fanshawe College’s training modules to submit the application.

*Please upload proof that shows your company has successfully completed Fanshawe College’s training modules.

Drop files here or click to upload. Make sure the file is a .jpg, .png or .pdf file.

*What is your main source market? (The country from which you recruit most of your students)

Other source markets

*Contact First Name

*Contact Last Name

*Position in the Company

CICC Consultant ID#

*Email Address

Website Address

*Main Office Street Address

*City

*Country

Postal Code

*Phone Number

*Is your company registered in Canada for HST?

Yes

Please provide the HST number

*Is the name to appear on commission cheques or bank (wire) transfers different from Company name?

Yes

Please provide the name

If you are not the authorized contract signatory, select this box.

Signatory First Name

Signatory Last Name

Signatory Position in the Company

Signatory Email Address