AFISS                                    

SERVICE REQUEST FORM                                                                                                                 

(Person submitting Application) Title:

Please Select Mr. Mrs. Ms. Miss Dr. Prof.

Name:

Position:

Company:

Type of business:

No of Employees:

Please Select  1-50  50-100 More than 100

Address:

City:

State/Province:

Post Code:

Country:

Telephone:

Fax:

E-mail:

Web:

 Number of Training Candidates if applicable:

Use this space for any additional comments:

Total Amount:

CDN$  or US$ 

Refer to or request AFISS   fee schedule for the applicable charges.

Otherwise  CONTACT US  for quotations.

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Cheques are to be made payable to: Amiri Food Industry Support Services

Ontario, Canada

For CREDIT CARD payments, submission by FAX  to +519-323-4453  is recommended to ensure privacy.

How did you hear about AFISS ? Please Select  Internet  Magazine advertisement Industry Colleague Other

Please review the completed form to ensure that the information provided is correct.