DRAGLAM SALT INC. PREFERRED DISCOUNT CARD REQUEST FORM

Fax To: (905)738-5228
ATTENTION: Sarah
OR
Drop-Off:
Draglam Salt Head Office 401 Bowes Road, Concord, Ontario L4K 1J4 Canada
Company Name: Title:
First Name: Last Name:
Office Phone: Mobile Phone:
Fax:    
Street Address: City:
Postal Code: Province:
Requested Balance Amount $:    
# of Cards Required:    
Amount per Card $:    
Method of Payment
Visa  MasterCard   Amex  Cash  Certified Cheque*

Draglam Salt Preferred Discount Card Terms & Conditions

  1. All methods of payment accepted for activation and/or refills. *No personal cheques accepted;must pay by Certified Cheque.
  2. Minimum activation amount is $5000 CDN.
  3. Minimum refill amount is $1000 CDN.
  4. Card Activation/Refills can ONLY be done between the hours of 9am-5:30pm Monday through Friday at our head office location (401 Bowes Rd).
  5. UNUSED BALANCES ON CARDS WILL CARRY OVER TO THE NEXT WINTER SEASON AND THERE ARE ABSOLUTELY NO REFUNDS AT ANYTIME FOR OUTSTANDING BALANCES CARRIED ON CARDS.

AGREEMENT
I fully understand and accept the Terms & Conditions of the Draglam Salt Preferred Discount Card.


NAME:
(Please print first and last name)
SIGNATURE:

TITLE:
(Owner, partner etc.)
DATE: