613-354-6505
Bulk Fuel Delivery | Lubricants | Heating & Cooling Equipment | CardLock / PetroVend     
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PERSONAL ACCOUNT APPLICATION
Primary Name on Account: Secondary Name on Account:
Mailing Address:
City:
Postal Code:
Telephone:
Delivery Civic Address:

Previous Address if less than 1 Year:
CREDIT INFORMATION
Name of your Employer:
Address:

We will contact you for your Banking Information 		ARE YOU A TENANT
Landlord's Name:
Telephone:
DELIVERY / SERVICE INFORMATION
Distinguishing Characteristics of Home or Additional Directions:

FUEL TYPE REQUEST
Furnace Oil     Stove Oil     Clear Diesel
Coloured Diesel     Thermaclean 		Automatic Delivery
Will Call for Delivery      
Amount of Fuel in Tank
Tank Size:
Tank Fill Location:
Are you requesting Service?
Oil Air Conditioning
Other 		Is your Domestic Hot Water Heated by Oil? Yes
Additional Comments or Requests:
CREDIT TERMS: 2% per month on accounts over 30 days. (24% per Annum). Accounts with balances over 60 days past due will be placed on C.O.D. until outstanding balance is paid.
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I agree that McKeown and Wood may obtain credit information as deemed necessary to establish a
credit account with this company (type yes or no)