Become a Customer

Interested in becoming a customer of Manitoulin Fuels? Fill out the form below to get started.

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Customer Information

Business/Company Name:

First Name: *

Middle Name: *

Last Name: *

S.I.N:

Date Of Birth: *

Spouse Information

Business/Company Name:

First Name:

Middle Name:

Last Name:

S.I.N:

Date Of Birth:

Contact Information
Delivery Address

911 Address:

P.O. Address:

City: *

Province: *

Postal Code: *

Mailing Address (If Different from Delivery Address)

911 Address:

P.O. Address:

City:

Province:

Postal Code:

Previous Address

911 Address:

P.O. Address:

City:

Province:

Postal Code:

Contact Information

Home Phone: *

Cell Phone:

Fax:

Email: *

Financial Information
Employment Information

Employer: *

Business Phone: *

Ext:

Banking Information

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

OwnedRented

Mortgage Company:

Landlord:

Farm Information

Lot:

Concession:

Township:

Acres Owned:

Owner:

Corporate Information

Corporate Name:

Directors:

Name:




Address:




Officers:

Name:




Title:




Customer Type

Type:

Supplier TransferNewAccount TransferOther

Converted From:

GasPropaneElectricWood

Supplier:

PST Exemptions

If you are PST exempt please fill in your PST number:

PST Number:

Heating Equipment Information

Type:

GasPropaneElectricWoodPool Heater

Furnace Condition

Condition:

OKNeeds WorkNo Furnace

Make:

Model:

Year:

Serial Number:

Boiler Condition

Condition:

OKNeeds WorkNo Boiler

Make:

Model:

Year:

Serial Number:

Water Heater Information

Type:

GasPropaneElectricWoodOil Fired

Condition:

OKNeeds Work

Size:

Make:

Model:

Year:

Serial Number:

Air Conditioner Information

Condition:

OKNeeds WorkNo A/C

Make:

Model:

Year:

Serial Number:

Tank Information
Gas

Size: Litres

Current Fill Qty: Litres

Tank Location:

Fill Location:

Serial Number:

Year:

Current Condition:

OKNeeds Work

Diesel

Size: Litres

Current Fill Qty: Litres

Tank Location:

Fill Location:

Serial Number:

Year:

Current Condition:

OKNeeds Work

Stove Oil

Size: Litres

Current Fill Qty: Litres

Tank Location:

Fill Location:

Serial Number:

Year:

Current Condition:

OKNeeds Work

Furnace Oil

Size: Litres

Current Fill Qty: Litres

Tank Location:

Fill Location:

Serial Number:

Year:

Current Condition:

OKNeeds Work

Air Miles Information

Sign-Up For New AccountNo ThanksExisting Air Miles Account

Air Miles Number:

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Other Information

I understand and agree to the terms of submission for this electronic form. By submitting this electronic application I hereby grant Manitoulin Fuels, 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 Manitoulin Fuels privacy policy and understand any liabilities and limitations of electronic submission as outlined in the Electronic Submission Statement found in the privacy policy.