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 1J1 Canada		  
Company Name: Title:
First Name: Last Name:
Office Phone: Mobile Phone:
Fax:    
Street Address: City:
Postal Code: Province:
# of Cards Required:    
Requested Balance Amount $:    
Method of Payment
Visa  MasterCard   Amex  Cash  Cheque*

Draglam Salt Preferred Discount Card Rules and Terms

  1. All methods of payment accepted for activation and/or refills. Please allow for 1 week processing time when paying by cheque (unless certified)
  2. Minimum activation/refill amount is $1000 CDN
  3. Card Activation/Refills can ONLY be done between the hours of 9am-6pm Monday through Friday at our head office location (401 Bowes Rd). A $1.50 Service Charge will apply for each refill.
  4. 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 Rules and Terms of the Draglam Salt Preferred Discount Card.


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

TITLE:
(Owner, partner etc.)
DATE:

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