Park Fuels :: Supply Agreement Forms

I, the undersigned, authorize Park Fuels Ltd. to verify the information contained in this agreement. I also authorize the persons named as references as well as my bank to give additional information that is considered necessary in obtaining my margin of credit.

Natural Gas Supply Agreement

Customer Name:
Telephone #:	1 - - -
Contact Person:
Fax #:	1 - - -
E-mail:
Service Address:
City:
Province:
Postal Code:	- (example: E1A - 2B4)
Mailing Address (If different):
City:
Province:
Postal Code:	- (example: E1A - 2B4)

Do you claim exemption from NB Sales Tax (HST)? If yes, please provide documentation of this exemption (i.e. exemption certificate, etc.) Yes No Fax or mail to the number, address above.
Initial Date of Gas Service (MM/DD/YY):
Pricing:	Market Based Pricing
Buyer Authorized Signature & Date

Birth Date:
Contact Home Number:	1 - - -
Contact Work Number	1 - - -
Fax #	1 - - -
Employer
Address of Employer
City:
Province:
Postal Code :	- (example: E1A - 2B4)
Years with Employer	Years
Position
Name of Spouse
Employer of Spouse
Address of Employer
City:
Province:
Postal Code :	- (example: E1A - 2B4)
Years with Employer	Years
Position
Bank & Branch
References: (i.e.) Dept stores, Banks, Mortgage co., visa
Prev. Owner or Occupant
How Long at Present Address	Years
Previous Address
How long at Previous Address	Years
Previous Fuel Supplier

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Contact Us

Park Fuels Ltd.
257 Metcalf Street
Saint John, NB
E2K 1X9
Tel: (506) 634-7275
Fax: (506) 634-8398
Toll Free: 1-866-634-7275
Email: info@parkfuels.com

Natural Gas Supply Agreement in a pdf format (345K)

Please fax this completed agreement to: 1-506-634-8398

mail agreement to:
Park Fuels Ltd.
P.O. Box 2241
E2L 3V1

Online Version