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First Name*

Last Name*

Phone Number*

Email*

Which service do you require? Record Suspension / U.S. Entry Waiver / Both / Not Sure*

Have you completed all parts of your sentence (including jail, probation, and fines)? Please answer: Yes or No*

Date you completed all parts of your sentence (YYYY-MM-DD)*

Have you been convicted of more than one offence? Please answer: Yes or No*

Have you ever been denied entry at the U.S.–Canada border? Please answer: Yes or No*

How was your offence prosecuted? Indictment / Summary conviction / Not sure*

Year of first conviction (YYYY)

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