CAMPUS

7601 Jane Street, Concord, Ontario L4K 1X2

www.fcmtcollege.com

AGENT APPLICATION FORM

1. COMPANY INFORMATION

Name of Company: Website:

Email Address: Phone Number:

License / Registration No. How long have you been operating?

Complete Address (Head office) :

How many branches you have and in Which cities/countries:

List the services that you provide:

Which countries you recruit students for?:

2. OWNER’S INFORMATION

Name: Email: Cell Phone:

3. List your Staff whom we will be working with:

Name: Email: Title:

Name: Email: Title:

4. Please answer the following questions

How many students do you recruit for Canadian Institutions per intake (On Average)?

How many students received visa approval for Canada last year?

How many students on an average do you anticipate sending to FCMT College?

Canadian Educational Institution that you currently work with:

5. Please provide your Banking Information for direct deposit of commission.

Name of Bank:
Beneficiary Name:
Account No.:
Swift Code:

Full Address of Bank:

Signature of Agent Representative Name of Agent Representative Date of Application: