ORDER FORM INSTRUCTIONS NEXUS PACKAGE CHECKLIST

* Initial review of your application entailsbackground checks in both Canada and the US* Once you have been conditionally approved, you canschedule an interview; you must schedule this interviewwithin 30 days of approval* Once you attend your interview and have been approved,your card will be mailed to you at the address you provide* Sending incomplete applications will delay processingCONSENT & DISCLAIMERThe applicant agrees to all of the following conditions* NEXUS Pass is not responsible for applications sent by mail or improperly submitted by email or fax* NEXUS Pass is not responsible for applications that are denied* NEXUS Pass is not responsible for delays caused by incomplete applications* The service fee is non-refundable once applications are submitted to the government* Government fees are non-refundable in all cases* I assert that I understand I am using NEXUS Pass to apply for my NEXUS card* I agree that the government fee will be taken from the credit card PASS APPLICATION * I

From (YYYY/MM) Street number Street name Apt. number City Province/State Country Postal/Zip code. Previous address (if applicable): To (YYYY/MM) From (YYYY/MM)

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