Visitor Tax Refund Agreement, G.S.T. / H.S.T.

A.

Date of arrival in Canada:	//	Date of departure from Canada:		//
	(Year / Month / Day)			(Year / Month / Day)

Last Name:
First Name:
Mailing Address:
City:		State/Province:
Country:		Postal/Zip Code:

B. TERMS

The above-named person (hereafter referred to as the "client") hereby gives Calforex absolute and irrevocable full power of attorney to handle, submit, receive, endorse and deposit all monies, receipts and documentation concerning assessment or reassessment of the tax refund for visitors by Revenue Canada on behalf of the client. Calforex agrees to refund the client any refundable taxes in accordance with the set.

C. CLIENT CERTIFICATION

By signing this document I hereby state that I am not a resident of Canada and all information contained within Part A of this application is true, correct and complete in every respect. I certify that all goods represented by the receipts submitted within this claim have been removed for permanent use outside of Canada within 60 days of purchase. With respect to the receipts herewith submitted, I hereby certify that I have not made any other claim for a visitor tax refund with Calforex, nor claimed privately through Revenue Canada, or through any other refund agent. I hereby agree to all of the terms and guidelines established by Revenue Canada and the terms established by Calforex within Part B of this agreement. Calforex is not an agent of Canada Customs & Revenue Agency or the Canadian Government.

Client's Signature: _______________________________	Date:	//
		(Year / Month / Day)