STEP 1: FILL OUT APPLICATION

Complete Section B:
“Applicant Information”
Ensure to check off the “New Card” box. The form can be found below.

Complete Section C:
“Health Care Professional Authorization”
To be completed by an authorized healthcare professional. Please refer to Section C for a list of accepted health care professionals.

Complete Section D:
“Administration Fee Payment”

STEP 2: MAKE PAYMENT

Administration Fee

• $25 for a new 3-year card
• $35 for a new 5-year card

Paying via Mail
Please ensure the cheque or money order mailed to our office is:

• Payable to “Easter Seals Canada”
• Dated within the last 6 months
• Signed

Paying online
Payment can be made online with a credit card, Visa/MasterCard Debit, or PayPal account.

• When purchasing an Access 2 Card online, the purchaser’s information will be automatically input under the Access 2 cardholder’s information on the next page. If the purchaser and Access 2 cardholder are different, please manually delete and input the cardholder’s name on the next page.

STEP 3: SUBMIT YOUR APPLICATION

There are three ways you can submit your application: by e-mail, fax, or mail.

• Email: access2card@easterseals.ca 
• Fax: 416-932-9844
• Mailing Address: 40 Holly Street, Suite 401, Toronto ON, M4S 3C3

Please submit sections B, C, and D.