Nominate

PowerAssist Technologies is a proud sponsor and member of the

Burlington Chamber of Commerce

Please provide the following contact information for the company that you wish to nominate.

I wish to Nominate a company in the following category

(You may select more than one category if you are not sure)

Category:

Manufacturer

Retail/Wholesale

Service Industry Innovative Technology New

New Product/ New Service New Small Business New

Mayor's Business Community Service Not sure on Category

I NOMINATE...

Name

Title

Organization

Street Address

Address (cont.)

City

Province

Postal Code

Work Phone

FAX

E-mail

URL

Why do you think that this company deserves to be considered for a Business Excellence Award?

NOMINATOR Information

Your Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail

Would you like to be a sponsor?

PowerAssist Technologies Inc.

(905) 690-3769

Category:	Manufacturer	Retail/Wholesale
	Service Industry	Innovative Technology New
	New Product/ New Service New	Small Business New
	Mayor's Business Community Service	Not sure on Category

Name
Title
Organization
Street Address
Address (cont.)
City
Province
Postal Code
Work Phone
FAX
E-mail
URL