Fields in red are required fields and MUST be completed.

business name:
type of business:
address:
city:
province:
postal code:
name of owner:
ownder contact number:
business phone:
business fax:
email:
offered discount:	*can be zero
website:
special exemptions or other offers:
Please enter the text you see in the graphic below into the box to verify that this is a genuine application. If you cannot read the letters, please click on the graphic to generate a new image.
CONFIDENTIALITY AGREEMENT I authorize the Victoria Pride Society to collect and maintain the above personal / business information. This information may be used to contact you to confirm your discount or special offer. My name and address will be retained on file. My information will be used for these purposes only and shall be held in strict confidence. By clicking the submit button, you agree that you have read and understood the above mentioned agreement and that you have consented to a discount to be offered to all valid Pink Link holders. Clicking submit is considered the same as a physical signature on a paper agreement.