Client Information Request Form

Please note: The fields marked * are mandatory.
Select a date from the calendar.
Full Name*
Postal Code
Business Phone
Alternate Phone
Company Name
Type of Company
Business Start Date
Select a date from the calendar.
How did you hear about us
Would you like to be added to our mailing list for newsletters and event announcements?*

Change the CAPTCHA codeSpeak the CAPTCHA code
*Please type the letters appearing in the image above. Why do I need to do this?

Privacy Statement

The personal information on this form is collected under authority of the Municipal Act SO 2001, c. 25. Questions about the collection of personal information should be directed to our Call Centre by dialing 3-1-1 (within Brampton city limits) or 905.874.2000 (outside city limits). Please review the City’s Privacy Statement for more information.