Seneca International Student Website -- New Agent Application Form

Salutation:

* Last Name:

* First Name:

* Title:

* Address:

* City:

* Country:

* Postal Code:

* Telephone:
(primary)

Telephone:
(alternative)

Fax:

SKYPE:

* Email:
(primary)

* Owner's Email:

IMPORTANT NOTE:

Please ensure the information provided below is accurate.

* Business Type:

* Legal Name:

* Business Registration Number:

* Address:

* City:

* Country:

* Postal Code:

Website:

Actions	Role	Officer

References: (Please Note: Seneca will check these references.)
* Reference 1:
* Reference 2:
China State Ministry Certification (copy):
* Company Profile:
* Business Plan:
* Owner's Resume:
* Copy of Registered Business License: