2011/11/22
FACILITY
INFORMATION
FACILITY NAME CHAIN
FACILITY LOCATION ADDRESS FRANCHISE
CITY POSTAL CODE
FACILITY MAILING ADDRESS SAME AS FACILITY OR
TELEPHONE FAX
E-MAIL WEBSITE
OPERATOR NAME
FACILITY’S
REGISTERED
OWNER(S)
REGISTERED OWNER NAME SOLE PROPRIETOR
MAILING ADDRESS PARTNERSHIP
CITY POSTAL CODE INCORPORATED
TELEPHONE FAX
E-MAIL WEBSITE
BUILDING
INFORMATION
BUILDING/PROPERTY ADDRESS INFORMATION SAME AS FACILITY ADDRESS
BUILDING OWNER INFORMATION SAME AS FACILITY OWNER
BUILDING OR
COMPLEX
IS THE FACILITY PART OF A MALL? IF SO, MALL NAME
BUILDING NAME (IF DIFFERENT FROM FACIILTY)
ADDRESS CITY POSTAL CODE
OWNER OF
BUILDING OR
COMPLEX
REGISTERED NAME SOLE PROPRIETOR
MAILING ADDRESS PARTNERSHIP
CITY PROVINCE POSTAL CODE INCORPORATED
TELEPHONE FAX
E-MAIL WEBSITE
EQUIPMENT
INFORMATION
[INDICATE ANY LEASED
EQUIPMENT WITH AN
ASTERISK (*)]
MODEL
SERIAL NUMBER
MANUFACTURE
DATE
MANUFACTURER ADDRESS
NOTES
SIGNATURE
SIGNATURE DATE
PRINT NAME
TANNING FACILITY INFORMATION FORM
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