CORPORATE CARE INC
 SIGN UP FORM for OWNER OPERATORS/SOLE PROPRIETORS
PRIVATE HEALTH SERVICES and COST PLUS PLANS

3024 Roblin Blvd Winnipeg MB R3R0B9
Administrator's Fee: 5% OF ALL CLAIMS SUBMITTED (GST on Admin fee Extra) plus a $10.00 processing charge.*
 +
Have you been engaged in your business on a regular and continuous basis
in the current and previous year? *
Is more than 50% of your total income from your self employed business? *
OR ....   Is your income from other sources less than $10,000? *
I learned about Corporate Care from:
Emailing this form constitutes Agreement to the Terms and Conditions of Corporate Care's Private Health services Plans and Cost Plus Plans. *