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Exam Room Rental Expense Report
Facility Name: *
Your answer
Proctor's First Name: *
Your answer
Proctor's Last Name: *
Your answer
Exam Date: *
MM
/
DD
/
YYYY
Site Rental Expense Calculation
Enter either the flat fee or the rate charge, depending on your rental venue.
Flat Fee:
Your answer
Rate is calculated per:
Only answer if site rental is charged on a rate charge.
GST/HST:
Dollar ($) value
Your answer
Total: *
Dollar ($) value
Your answer
Site Rental Payment Information
Payable to: *
Your answer
Name/Institution: *
Your answer
Address 1: *
Your answer
Address 2:
Your answer
City: *
Your answer
Province: *
Postal Code: *
Please use format A9A 9A9
Your answer
Credit Union Institute of Canada
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