Payline Financial Registration Please fill out the required fields below. This form must be completed prior to booking a transaction online with Payline. (Fields marked with * are required.) Registration Type Individual Sole Proprietor Corporation * Last Name * First Name Legal Company Name * Street Address * City * Province/State * Postal/Zip * Country * Email Website * Contact Number Fax Are you Importing Exporting? What are the main foreign currencies being used?    (please check all that apply) USDEURGBPAUDJPY Frequency of Transactions Weekly Monthly Quarterly Periodically How did you hear about us? Client Relationship Manager Agent Referral Existing Client Tradeshow Google Advertisement TelPay Inc. Other Select Account Manager Alvin Arruda Andrew Zippan Grant Smith Jennifer Hannah Jonathan White Ken Fukami Lewis Stoyles * Requested Username: * Requested Password:   (at least six alphanumeric characters) Subscribe to market update emails? Yes No