new Account information

Business Profile

Please complete the following information. All required fields are marked with *
For United States profiles please call 1.866.944.6210
 
Are you an existing SOCAN licensee? ?   Yes    No
 
Licensee Name  ?
     
Licensee Address  ?
*
   
   
City  ?
*
Province  ?
*
Postal Code  ?
*
Same mailing address  ?
* Yes No
Establishment Address  ?
*
   
   
City  ?
*
Province  ?
*
Postal Code ?
*
Licensee Type  ?
*
 

How did you hear about SOCAN

* Please select one of the following.
   
* If you select "other" please provide additional information in the space below.
   
 
 

Primary Contact Information

 
First Name   *
Last Name    *
Email  (This is your User ID) ? *
Email Confirmation   ? *
Phone Number   ? *
Fax Number   ?  
     
Create your password  ?
 
Confirm your password  ?
 

If the contact person for mailing or billing is different than the Primary Contact identified, you will have the opportunity to add more contacts once the registration process is complete and you are in the secure section.