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Heaven Sent Lifestyle Management Inc.
1-888-773-3953


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Individual Customer Inquiry Form

All information provided by our clients is kept in the strictest of confidence with careful adherence to the privacy laws. Mandatory fields are indicated by an asterisk (*), all other fields are optional

 
 

   Caller/Customer Information

   
*Full Name: 
*Title: 
*Telephone: 
City & Province : 
Postal Code: 
*Email Address: 

Are you consideringa membership for yourself?: 

 Yes
No

Are you looking to purchase a GIFT membership for someone else?: 

 Yes
No
   

    Services of Interest

   
Please indicate the services of interest to you:
Seniors Services
Disabled Adults
Busy Individuals / New Moms or Dads
Self-Employed/Entrepreneurs
Corporate Employee Benefits/Rewards
Errands / Concierge
Weekly Groceries/L. Housekeeping/Laundry
Gift Shoppping
Party/Small Event Planning
Other

   Preferred Method of Contact

Email
Phone

What additional information would you like? 

 



 
 
   
 

* Required fields.
 
   
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