Aviation Application Form

Become An Edward Fuels Customer

* – Required

Download PDF Version

Information

Customer / Airport Location: *

Dealer: *

Web Site:

Hours Of Operation

Mon:
From:

To:

24hrClosed

Tue:
From:

To:

24hrClosed

Wed:
From:

To:

24hrClosed

Thu:
From:

To:

24hrClosed

Fri:
From:

To:

24hrClosed

Sat:
From:

To:

24hrClosed

Sun:
From:

To:

24hrClosed

Address Information

911 Address: *

Town: *

Postal Code: *

Phone: *

Ext:

Fax:*

Contact Information
Primary Contact Person

Name: *

Work Phone: *

Ext:

Cell Phone:

E-Mail: *

Airport Manager

Name: *

Work Phone: *

Ext:

Cell Phone:

E-Mail: *

Fuel Information

Current Supplier:

Aviation Fuel Available On Site
JETA1

Storage Capacity: Litres

Above Ground: Litres

Under Ground: Litres

Cabinet: Litres

Annual Estimated Sales Volumes: Kilolitres

AVGAS

Litres

Litres

Litres

Litres

Kilolitres

Refueling Assets Owned By:

Posted Airfield Fuel Prices (Fill In What You Can)

Pricing Date: *

Aviation Fuel Costs
JETA1

Cost (Excluding GST): $

Airport Fee: $

Margin: $

Retail: $

Discounts - Tenants: $

AVGAS

$

$

$

$

$

Special Instructions / Comments

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
Mailing Address

911 Address: *

P.O. Address: *

City: *

Province: *

Postal Code: *

Corporate Information

Corporate Name:

Directors:

Name:




Address:




Officers:

Name:




Title:




Banking Information

Bank Name: *

Branch Location: *

PST Exemptions

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

PST Number:

Credit References (3)

Organization Name: *

Contact Person: *

Phone: *

Ext:

Organization Name: *

Contact Person: *

Phone: *

Ext:

Organization Name: *

Contact Person: *

Phone: *

Ext:

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.