Please have one of your representatives contact me as soon as possible, with no further commitment on my part.

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I can be reached at :
 
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*
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*
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*
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Address :
*
City :
*
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*
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*
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*
 
Address of the home for sale (if other):

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Homeowner's Description Sheet
 
 

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Plan

Plan A

Plan B

Term :

6 months

12 months

Cost of your Publiweb :

549,00 $

749,00 $

GST ( #862654522)

38,43 $

52,43$

QST (#1023755137)

44,06 $

60,11$

Total :

631,49$

861,64$

Your choice : Plan A (631,49$)
Plan B (861,64$)
Name of cardholder :
Card type :
 Master Card     Visa
Card number :
Expiration date :
Mois:    Année :