
| SECOND MEMBERSHIP INFORMATIONS | |
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| Second card: | I want a 2nd membership card ** Required if the second card is checked |
| ** Type of subscription: |
New member Renewal; Membership # : |
| ** Package: |
LIFETIME membership : $130.00 + taxes
For a limited time: Including a transport worth $50.00.
For a limited time: Including a transport worth $50.00. Service valid for the member and the people in the same vehicle as him only: More details |
| ** First name: | |
| ** Last name: | |
| ** Address: | |
| ** City: | |
| ** Postal Code: | |
| ** Date of birth (dd/mm/yy): | |
| ** Phone at home: | |
| Office phone: | |
| Cellphone : | |
| Email: | |
| Get some prepaid transports in the form of gift cards | |
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| In case of emergency, do you want to add gift cards ? Yes No |
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| x $8.00 N.B. Each gift card has a value of $8.00, no expiry date. |
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| Take no chance, get some disposable breathalyzers | |
|---|---|
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Yes
No
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Disposable breathalyzers are offered to you at the price of $4.00+tx.
For more details see this page.
** Required if you select 'Yes'. |
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| ** Number of breathalyzer(s) ? : |
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Freight and handling From 1 to 4 breathalyzers : FREE From 5 to 15 breathalyzers : $8.00(Canada Post) 16 breathalyzers or more : $20.00 (Purolator with signature) If you come to our office = $0 6921 Jarry East, St-Leonard, Quebec, H1P 1W7, from Monday to Friday between 11:00AM to 9:00PM |
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| USE THIS FIELD TO LEAVE A MESSAGE TO POINT ZERO 8 | |
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| METHOD OF PAYMENTS | |
| Paypal / Credit card (Immediate Subscription, secure site) | |
| Check / Money Order (Mail Subscription) |
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