Register a Personal Service Business

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Personal information on this form is collected under the authority of section 2(1) of the Personal Service Regulations made under the Public Health Act, R.S.P.E.I. 1988, Cap. P-30.1, and under authority of section 31 of the Freedom of Information and Protection of Privacy Act, R.S.P.E.I. 1988, Cap.F-15.1, as it relates to the operation of a personal service establishment. If you have any questions about the collection or use of this personal information, you may contact Environmental Health at 902-368-4970.

Identification

Enter "N/A" in the Business/Organization Name field if there is no business name.

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address

Business Website URL

Is the business's civic address different than above?

Business's Civic Address

Civic Address

Civic location where your business will be conducted.

City, Town, or Community

Postal Code

For example: C1B 0X1 or 12345