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Copyright Document Order Form

* Mandatory Fields

Greeting

*First Name

*Last Name

Email address

Telephone

() –

(Extension or International phone number)

Fax

() –

International fax number

Organization

Street

City

Province

State (US residents)

Postal / Zip Code

Country

Please indicate the documents you wish to receive.Select Documents Instructions:

Enter the document number.

Select the type of document.

If certification if required, check "Certified"

Repeat as necessary.

Document NumberType of DocumentCertifedCopies

Delivery and Payment:

*Delivery method:

If you select Fedex or Purolator for delivery, please provide your account number in the Comments field.

**For security measures, our Office will contact you to obtain your credit card information.

*Payment method:

CIPO deposit account number:

Client reference number (if applicable):

Note: It is our policy to contact clients to confirm the cost and to finalize delivery and payment details.

*How may we contact you?

Additional Comments

Protected when completed.