MICROBITEC CORPORATION - Application Form


	Name
	Address
	Title or Position
	Business Name
	City
	ProvinceState
	PostalZip
	Work Phone
	Email
	Implementation of BEVERAGE CERTIFICATION PROGRAM for CERTIFICATION TYPE A	Restaurant Pub Lounge Bar Club Convenient store Draft beer systems Liquor dispensing systems Pop juice dispensing systems Ice machines Glass washers
	Additional Information

Annual fee due at time of application $180.00 + $12.60 GST = $192.60

Please send a cheque payable:
MICROBITEC CORPORATION
3880 Dunbar Street,
Vancouver B.C.
V6S 2E2