Registration Form

TakeaTaxi.ca Ordering Instructions:

1. Complete the registration form below.
2. Print the completed form.
3. Send a copy of the completed form along with a cheque or money order payable to:

     SK8 Wireless Technologies Inc.
     110 Renfrew Ave.
     Ottawa, Ontario
     Canada
     K1S 1Z8

Note: each listing fee is applicable to one city and immediate surrounding area only.

Customer Information

Name:

First	Last

Company:

Address line 1:

Address line 2:

City:

State / Province:

Zip / Postal Code:

Country:

Telephone:

E-Mail Address:

Confirm E-Mail:

Taxi Listing Information

Taxi Service Name:

(one per form)

Taxi Service Phone Number:

(one per form)

City Listing:

(one per form)

Ranking Choice

Gold Listing - The first two ranking for each city are reserved for gold members
-only $12.99 CAD each / year

Silver Listing - The third and fourth ranking for each city are reserved for silver members
-only $9.99 CAD each / year

Bronze Listing - The fifth and sixth ranking for each city are reserved for bronze members
-only $5.99 CAD each / year

Questions or comments: SK8-Wireless@Rogers.com