The application must be filled out in full. A certified cheque
for $10,000 must accompany the application.
The total cost for a ten-year lease is $30,000.
The cheque should be made payable to:
Blythman Agencies Ltd.
In Trust
Box 729
Maple Creek, SK
S0N 1N0
The application and certified cheque must be mailed to:
Blythman Agencies Ltd.
Box 729
Maple Creek, SK
S0N 1N0
| Full name of leaseholder: |
| ......................................................................................................................................................................... |
| Full name of second leaseholder if applicable: |
| ......................................................................................................................................................................... |
| Full address of leaseholder one including postal code: |
| ......................................................................................................................................................................... |
Full address of leaseholder two including postal code: |
| ......................................................................................................................................................................... |
| Telephone number of leaseholder one |
| Work:.............................................................................................................................................................. |
| Home:............................................................................................................................................................. |
Cell:................................................................................................................................................................. |
| Fax:.................................................................................................................................................................. |
| Email:.............................................................................................................................................................. |
| Telephone number of leaseholder two |
| Work:.............................................................................................................................................................. |
| Home:............................................................................................................................................................. |
Cell:................................................................................................................................................................ |
| Fax:................................................................................................................................................................. |
| Email:.............................................................................................................................................................. |
Date:
..............................................................................................................................................................
Signature:
..............................................................................................................................................................