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Canada Billing Application

Type of Billing

*Applying For?:	Applying For?, field is required, to switch between list items use arrow buttons.
*Want AMEX?:	Want AMEX?, field is required, to switch between list items use arrow buttons. function changeValue900e3b7a77ad4257bc80c8319cb7c4a0();{var controlField900e3b7a77ad4257bc80c8319cb7c4a0=$('#fld_900e3b7a-77ad-4257-bc80-c8319cb7c4a0'); var controlFieldValue = controlField900e3b7a77ad4257bc80c8319cb7c4a0.attr('value'); var dependentFieldfedf8092c6074e1795efe7731633635f = $('#fld_fedf8092-c607-4e17-95ef-e7731633635f'); var dependentFieldLabelfedf8092c6074e1795efe7731633635f = $('#label_fedf8092-c607-4e17-95ef-e7731633635f'); var dependentFieldTooltipfedf8092c6074e1795efe7731633635f = $('#tooltip_fedf8092-c607-4e17-95ef-e7731633635f'); var dependentFieldContainerfedf8092c6074e1795efe7731633635f = dependentFieldfedf8092c6074e1795efe7731633635f.closest('.page-layout-section'); if(controlFieldValue==="No"){ dependentFieldfedf8092c6074e1795efe7731633635f.hide();dependentFieldfedf8092c6074e1795efe7731633635f.attr('disabled','disabled'); dependentFieldLabelfedf8092c6074e1795efe7731633635f.hide(); dependentFieldTooltipfedf8092c6074e1795efe7731633635f.hide(); var dependentFieldfdContainerfedf8092c6074e1795efe7731633635f = $('#fdContainer_fld_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldfdContainerfedf8092c6074e1795efe7731633635f.hide(); dependentFieldfedf8092c6074e1795efe7731633635f.hide(); var isManagePicklistfedf8092c6074e1795efe7731633635f = dependentFieldfedf8092c6074e1795efe7731633635f.attr('is-manage-picklist')=='true' && dependentFieldfedf8092c6074e1795efe7731633635f.data('kendoDropDownList'); isManagePicklistfedf8092c6074e1795efe7731633635f ? dependentFieldfedf8092c6074e1795efe7731633635f.data('kendoDropDownList').enable(false):dependentFieldfedf8092c6074e1795efe7731633635f.attr('disabled','disabled'); var dependentFieldRequiredLabelfedf8092c6074e1795efe7731633635f = $('#requiredLabel_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldRequiredLabelfedf8092c6074e1795efe7731633635f.hide(); var dependentFieldfdcombidedContainerfedf8092c6074e1795efe7731633635f = $('#combidedControl_fld_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldfdcombidedContainerfedf8092c6074e1795efe7731633635f.hide(); var dependentFieldfldReadonlyfedf8092c6074e1795efe7731633635f = $('#fld_Readonly_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldfldReadonlyfedf8092c6074e1795efe7731633635f.hide(); dependentFieldLabelfedf8092c6074e1795efe7731633635f.hide();}if(controlFieldValue==="Yes"){ dependentFieldfedf8092c6074e1795efe7731633635f.not('.pm-checkbox').show(); var isManagePicklistfedf8092c6074e1795efe7731633635f = dependentFieldfedf8092c6074e1795efe7731633635f.attr('is-manage-picklist')=='true' && dependentFieldfedf8092c6074e1795efe7731633635f.data('kendoDropDownList'); isManagePicklistfedf8092c6074e1795efe7731633635f ? dependentFieldfedf8092c6074e1795efe7731633635f.data('kendoDropDownList').enable():dependentFieldfedf8092c6074e1795efe7731633635f.removeAttr('disabled'); dependentFieldLabelfedf8092c6074e1795efe7731633635f.show(); dependentFieldLabelfedf8092c6074e1795efe7731633635f.css('style','display:inline !important;'); dependentFieldTooltipfedf8092c6074e1795efe7731633635f.show(); dependentFieldTooltipfedf8092c6074e1795efe7731633635f.css('style','display:inline !important;'); dependentFieldContainerfedf8092c6074e1795efe7731633635f.show(); var dependentFieldRequiredLabelfedf8092c6074e1795efe7731633635f = $('#requiredLabel_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldRequiredLabelfedf8092c6074e1795efe7731633635f.show(); var dependentFieldfdContainerfedf8092c6074e1795efe7731633635f = $('#fdContainer_fld_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldfdContainerfedf8092c6074e1795efe7731633635f.hide(); var dependentFieldRequiredLabelfedf8092c6074e1795efe7731633635f = $('#requiredLabel_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldRequiredLabelfedf8092c6074e1795efe7731633635f.show(); var dependentFieldfdcombidedContainerfedf8092c6074e1795efe7731633635f = $('#combidedControl_fld_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldfdcombidedContainerfedf8092c6074e1795efe7731633635f.show(); dependentFieldfedf8092c6074e1795efe7731633635f.not('.pm-checkbox').show(); var dependentFieldfldReadonlyfedf8092c6074e1795efe7731633635f = $('#fld_Readonly_fedf8092-c607-4e17-95ef-e7731633635f'); dependentFieldfldReadonlyfedf8092c6074e1795efe7731633635f.show(); }} No
Have AMEX?:	Have AMEX?

Business

*DBA Name:	DBA Name, field is required
*Legal Business Name:	Legal Business Name, field is required
*Business Email:	Email, field is required
*Business Phone:	Business Phone, field is required
*Business Fax:	Business Fax, field is required
*Name On Statement:	Name On Statement, field is required
*GST Number:	GST Number, field is required
*Website:	Website
*Ownership:	Ownership, field is required, to switch between list items use arrow buttons. --None--
*Years In Business:	Years In Business, field is required
*Location Address:	Street City Country ProvincePostal code

Owner/Owners

*First Name:	First Name, field is required
*Last Name:	Last Name, field is required
*% of Ownership:	% of Ownership, field is required
*SSN:	SSN, field is required
*Title:	Title, field is required
*DOB:
*Phone:	Phone, field is required
*Home Address:	Street City Country ProvincePostal code

2nd Owner: First Name:	2nd Owner: First Name
2nd Owner: Last Name:	2nd Owner: Last Name
2nd Owner: % of Ownership:	2nd Owner: % of Ownership
2nd Owner: SSN:	2nd Owner: SSN
2nd Owner: Title:	2nd Owner: Title
2nd Owner: DOB:
2nd Owner: Phone:	2nd Owner: Phone
2nd Owner: Address:	Street City Country ProvincePostal code

Attach Documents

*VOID Cheque:
Identity Document:
Drivers License :