CONSENT FORM

 

Client Consent to Maintain and Use Personal Information

 

On January 1, 2004, the Government of Canada will fully implement the

Personal Information Protection and Electronic Documents Act (PIPEDA). 

Accordingly, in order to be in compliance with the Act, Uxbridge Travel Centre is required to obtain

consent from its customers in order to use personal information which we may already have on

file or in our data systems.  The personal information which we maintain and use is for the purposes

of servicing the travel arrangements which you request that we undertake

and to inform either verbally, by postal mail or e-mail of future travel promotions.

 

This information is stored, secured, disclosed and handled in strict accordance with PIPEDA

and Uxbridge Travel Centre’s compliant Privacy Policy. 

Our complete policy is available on our web site at policy.html,

posted in our offices, and available anytime for your review and consideration. 

If you wish a copy sent to you via e-mail, please let us know.  We would also

be happy to forward our policy by postal mail as well.

 

                                                            CONSENT

 

Accordingly, I duly authorize Uxbridge Travel Centre to continue to maintain and use my personal

information which Uxbridge Travel

Centre may already have access to and to use same in strict accordance with the Privacy Policy stated by

Uxbridge Travel Centre.

 

Name:______________________  Date:____________  Signature:_______________________