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Customer Information Sheet
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* - Required  
Customer Information Spouse Information
Business/Company Name:
First Name: *
Last Name: *
S.I.N:
Date Of Birth: *
YYYY-MM-DD
Business/Company Name:
First Name:
Last Name:
S.I.N:
Date Of Birth:
YYYY-MM-DD
Contact Information
Delivery Address Mailing Address (If Different from Delivery Address)
911 Address:
P.O. Address:
City: *
Province: *
Postal Code: *
911 Address:
P.O. Address:
City:
Province:
Postal Code:
Previous Address Contact Information
911 Address:
P.O. Address:
City:
Province:
Postal Code:
Home Phone: *
555-555-5555
Cell Phone:
Fax:
Email: *

 
Financial Information
Employment Information Banking Information
Employer: *
Business Phone: * Ext:
Bank Name: *
Branch Location: *
Credit References (3)
Organization Name: *
Contact Person: *
Phone: * Ext:
 
Organization Name: *
Contact Person: *
Phone: * Ext:
 
Organization Name: *
Contact Person: *
Phone: * Ext:
 
Residence Information
Home Information Farm Information
Owned Mortgage Company:
Rented: Landlord:
Lot:
Concession:
Township:
Acres Owned:
Mortgage Company:
Acres Rented:
Owner:
Corporate Information
Corporate Name:
Directors: Name Address Officers: Name Title
Customer Type PST Exemptions
Type:  
Supplier Transfer   Supplier:
New  
Account Transfer  
Other
Converted From:
Gas Propane
Electric Wood
If you are PST exempt please fill in your PST number:
PST Number:
Heating Equipment Information
Type:   Gas   Propane   Electric   Wood   Pool Heater  
Furnace Condition Boiler Condition
Condition:     OK   Needs Work   No Furnace
Condition:     OK   Needs Work   No Boiler
Make:
Model:
Year:
Serial Number:
Make:
Model:
Year:
Serial Number:
Water Heater Information Air Conditioner Information
Type:     Gas   Propane   Electric   Oil Fired  
Condition:   OK   Needs Work
Size:
Make:
Model:
Year:
Serial Number:
Coondition:   OK   Needs Work   No A/C
Size:
Make:
Model:
Year:
Tank Information
Product Size Current Fill Qty Tank Location Fill Location Serial # Year Current Condition
Gas L L OK Needs Work
Diesel L L OK Needs Work
Stove Oil L L OK Needs Work
Furnace Oil L L OK Needs Work
Air Miles Information
Sign-Up For New Account Air Miles
No Thanks
Existing Air Miles Account
Air Miles Number:
Other Information
 
I understand and agree to the terms of submission for this electronic form. By submitting this electronic application I hereby grant Edward Fuels Limited, permission to confirm this information with the references listed or with any credit information service. I (the rightful owner of this personal information) also agree to the terms and conditions regarding personal information submission/storage/protection as found on the the Edward Fuels privacy policy and understand any liabilities and limitations of electronic submission as outlined in the Electronic Submission Statement found in the privacy policy.
 
Aviation Fuels and Lubricants
Edward Fuels is pleased to be the approved Shell Aviation distributor for southern Ontario. We look forward to supplying the aviation community and encourage your inquiries. 		  Home Comfort Experts
See how our experts can keep your home at it's best, no matter what mother nature is doing. 		  OBT Training
Get your Oil Burner Technican certification from Edward Fuels. A comprehensive program taught by our own experts. 		 
 
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