Application for Collector's License

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Personal information on this form is collected under Section 1.1 of the Collection Agencies Act, Regulations as it relates directly to and is necessary for an application to collect debt. If you have any questions about this collection of personal information you may contact the Consumer, Corporate and Financial Services, Prince Edward Island, 902-368-4550.

Identification

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

PEI Collection Agency License Number

Enter the four or five digit PEI Collection Agency License Number