Salutation:
First Name:
Last Name:
Registration Number:
Street Address:
Apt/Box#:
City:
Prov/State:
Postal/Zip Code:
Tel (home):
Fax Number:
Email Address:

Note: A name change requires documentation, e.g., photocopy of marriage certificate signed by guarantor to confirm documentation is a true copy of the original. This documentation must be mailed to the CMLTO office. A $15.00 administration fee will be charged if a new wallet card is required.