What is the effective date?(Required) What is the name of the Vendor?(Required) What is the Vendor’s address?(Required) Example: 123 Main Street, Vancouver, BC A1A 1A1What is the Purchaser’s name?(Required) What is the Purchaser’s address?(Required) Example: 123 Main Street, Vancouver, BC A1A 1A1What is the name of the Company?(Required) What is the incorporation number of the Company?(Required) What is the jurisdiction of the company(Required)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonWhat is the address of the Company?(Required) Example: 123 Main Street, Vancouver, BC A1A 1A1How many shares are being Purchased?(Required)How much is the purchase price?(Required)Please enter a number greater than or equal to 0.01.What is the share class?(Required) Example: Class A Common or Class B Preferred – DO NOT INCLUDE THE WORD “SHARE” OR “SHARES” IN YOUR ANSWER Who is the authorized signatory for the Company?(Required) Δ
