Sarnia Golf & Curling Club - Authorization to Perform Credit Check

Surname: *

First Name: *

Current Address: *

City *

Postal Code *

Email: *

Telephone: *

Date of Birth: *

Previous Address (if at current less than 7 yrs):

Previous Postal Code

CONSENT: I have read the Credit Extension, Accounts Receivable and Delinquency Policy and hereby give consent to Sarnia Golf & Curling Club of 500 Errol Road West, Sarnia, Ontario, Canada, to collect, use and disclose my personal information for purposes of determining my eligibility for membership and assessing my credit worthiness.

Date of Submission: * +

Signature: *

clear