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Airport Fueling Information Sheet
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* - Required  
Information Hours Of Operation
Customer / Airport Location:
*
Dealer:
*
Web Site:
Mon:
To
/ 24hr
 /
Closed
Tue:
To
/ 24hr
 /
Closed
Wed:
To
/ 24hr
 /
Closed
Thu:
To
/ 24hr
 /
Closed
Fri:
To
/ 24hr
 /
Closed
Sat:
To
/ 24hr
 /
Closed
Sun:
To
/ 24hr
 /
Closed
Address Information
911 Address:
*
Phone:
* Ext:
555-555-5555
Town:
*
Fax:
*
555-555-5555
Postal Code:
*    
Contact Information
Primary Contact Person  Airport Manager 
Name:
*
Work Phone:
* Ext:
555-555-5555
Cell Phone:

555-555-5555
E-Mail:
*
Name:
*
Work Phone:
* Ext:
555-555-5555
Cell Phone:

555-555-5555
E-Mail:
*
Fuel Information
Current Supplier:
Aviation Fuel Available On Site
JETA1
AVGAS
Storage Capacity:
Litres
Litres
Above Ground:
Litres
Litres
Under Ground:
Litres
Litres
Cabinet:
Litres
Litres
Refuelers:
Litres
Litres
Annual Estimated Sales Volumes:
Kilolitres
Kilolitres
Refueling Assets Owned By:
Posted Airfield Fuel Prices (Fill In What You Can)
Pricing Date:
* YYYY-MM-DD
Aviation Fuel Costs
JETA1
AVGAS
Cost (Excluding GST):
$
$
Airport Fee:
$
$
Margin:
$
$
Retail:
$
$
Discounts - Tenants:
$
$
Special Instructions / Comments
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
Mailing Address
911 Address: *
P.O. Address: *
City: *
Province: *
Postal Code: *
Corporation Information
Corporate Name:
Directors: Name Address Officers: Name Title
Banking Information PST Exemptions
Bank Name: *
Branch Location: *
If you are PST exempt please fill in your PST number:
PST Number:
Credit References (3)
Organization Name: *
Contact Person: *
Phone: * Ext:
555-555-5555
 
Organization Name: *
Contact Person: *
Phone: * Ext:
555-555-5555
 
Organization Name: *
Contact Person: *
Phone: * Ext:
555-555-5555
 
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
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