Application Number:

Customer Information Form

You have been approved for a Canadian Tire Bank issued Mastercard®, however, to meet government regulations, we
need to view your government issued photo ID before we issue your card. This can be done by visiting any Canadian Tire
store. Please bring the completed form, below, in-person to a Canadian Tire store when you feel safe to make a visit.
If this step is not completed by the date indicated in the email, your application will be cancelled and you will need
to reapply for this credit card.

Acceptable forms of Photo ID:

• Provincial Driver’s Licence • Permanent Resident Card
• Provincial ID Card • British Columbia Services Card
• Canadian Passport • Certificate of Indian Status Card
Note: A Quebec Health Card is not accepted as valid form of Photo ID.

1. Please complete the following:

Name of applicant as it appears on your application & ID:

ID type: (see list above) :

ID number:

ID place of issue:

ID expiry date:
MM/DD/YYYY

2. Bring this completed ID verification letter with your original ID (indicated above) to the customer service desk at
any Canadian Tire store.

3. When you receive your card, please call to activate it.

Thank you for your assistance in completing this Customer Information Form. We will send your new credit card to
you shortly.

CANADIAN TIRE CUSTOMER SERVICE (MUST COMPLETE THIS SECTION):

1. Fax this page to Canadian Tire Bank (“CTB”) at 1-800-454-1494 and shred original.

2. Today’s date: MM/DD/YY

3. Faxed by store # : Ext. (if applicable) :

4. Customer Service Representative Name (Please Print)

Customer Service Representative Signature:

IMPORTANT!
Please verify customer identification and confirm it meets outlined requirements.
FAXING THE COMPLETED LETTER RIGHT AWAY TO CTB IS VERY IMPORTANT.

®/TM
Unless otherwise noted, all trademarks are owned by Canadian Tire Corporation, Limited and are used under licence.
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