2018 Secondary Distributor (SD) Permit Renewal

Invoice # 1218
Due Now – Please Complete & Return with Payment
For the period January 1, 2018 – December 31, 2018
(Ozone Depleting Substances and Other Halocarbons Regulation 103/94)

A Secondary Distributor Permit is required in the Province of Manitoba, for companies who purchase regulated air conditioning
equipment/parts or substances, under Manitoba Regulation 103/94. A secondary distributor is a company that imports into the province or
purchases in the province an ODS or equipment, other than a white good (i.e. fridge, freezer). A SD permit allows the entity to purchase
regulated products (i.e. refrigerant, parts components). Contact MOPIA for more details or for a copy of the legislation.

Only certified individuals and secondary distributors may purchase regulated products as described under the MR 103/94. Section 22 of the
Regulation allows a person (i.e. corporation, company) who is not a manufacturer of a regulated substance or a trained service technician to
become a secondary distributor.

Company Identification (Please ensure the following information is correct)

Secondary Distributor Number
Company Name:

Address:

You may pay by cheque (payable to MOPIA) or credit card by mailing or faxing the completed form OR by
calling in your payment to 204.338.2222 or 1.888.667.4203 (outside Wpg) fax: 204.338.0810.

If mailing, please send your payment and detach the lower form info to:
MOPIA
1082 Main Street,
Winnipeg, MB
R2W 5J3

Upon payment and processing, MOPIA will email you a new electronic version of the 2018 permit.

Please direct any questions or concerns, email: mopia@mymts.net or call (204) 338.2222
Toll Free: 1.888.667.4203. We are here to assist!

If mailing, please detach the bottom section below and mail back to MOPIA along with you payment – Thank you!

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Invoice or PO #: SD Permit #
Credit Card #: _______________________________ Expiration date: ___________ or Cheque #: ________________
Signature: ________________________________Email 2018 Permit to: _______________________________
Payment: 2018 Secondary Distributor (SD) Permit (mandatory): $50 (fifty)
We try to keep our stakeholders informed. We would like to send you monthly updates that contain related information, as
well as, regulation news or updates, next available courses, awareness sessions being held and potential conferences.

 Yes, please email me related regulatory and MOPIA information to the email address:
________________________ (Free - No cost)
 Yes, please physically mail me this information to the address.
(Cost: $10 for paper and postage Total: $60) ________
 No, I do not wish to receive this information.
Total Paid ($50 or $60): ________