Portal Access Request

Please note: This form must be completed in one sitting, as progress cannot be saved.

We recommend saving a copy for your records using standard browser options such as Printing or Saving as PDF.

Organization Information

Organization Type

Business Legal Name

Enter the legal name of your organization.

Business Operating Name

Enter the operating name if different from the legal name.

Business Number

Enter your organization’s Business Number.

Business Website

Enter your organization’s website URL.

FINTRAC Registration Number

Enter your FINTRAC registration number.

RPAA Registration Number

Enter your Registration number under the Retail Payment Activities Act, if applicable.

Canadian Head Office Address

Address

Enter the primary street address.

City

Enter the city where your head office is located.

Building

Specify the name of the building, if applicable.

Floor-Suite

Specify the floor / suite, if applicable.

P.O. Box

Specify the Post Office Box, if applicable.

Province

Select the province or territory.

Country

Postal Code

Enter a valid Canadian postal code.

Location Type

Specify the location type.

Primary Business Contact

First Name

Enter the primary business contact's first name.

Last Name

Enter the primary business contact's last name.

Email Address

Enter the primary business contact's email address.

Preferred Language

Enter the primary business contact's preferred language.

Telephone Number

Enter the primary business contact's telephone number.

Telephone Extension

***

Enter the extension number.

Individual Submitting This Form

Same as Primary Contact

NoYes

First Name

Enter the submitter's first name.

Last Name

Enter the submitter's last name.

Email Address

Enter the submitter's email address.

Preferred Language

Enter the submitter's preferred language.

Telephone Number

Enter the submitter's telephone number.

Telephone Extension

***

Enter the extension number.

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Enter the code from the image

Language selection

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Organization Information

Canadian Head Office Address

Primary Business Contact

Individual Submitting This Form

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User & Account

User Roles

Org types

Pre-Eligibility