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Please check if we service your city/town and select your Service Branch State/Province and City before completing the rest of this form:
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State/Province:
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City:
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First Name:
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Last Name:
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Address:
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City/Town:
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Province:
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Postal Code:
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Email:
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Home Phone:
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Business Phone:
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Delivery Location same as above?
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Delivery Location
First Name:
Last Name:
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Province:
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SIN:
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Date of Birth (mm/dd/yy):
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Year
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Property Information:
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How Long (Years):
Previous Address
(check if less than 2 years)
Previous Address
Address:
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Province:
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Postal Code:
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Employer Name:
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Employer Address:
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City/Town:
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Occupation:
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Work Phone:
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How Long (Years):
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Employment Type:
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Reference Information
First Name:
Last Name:
Address:
City/Town:
Province:
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Postal Code:
Email:
Daytime Phone:
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Evening Phone:
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Previous Employment
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Previous Employment
Employer Name:
Employer Address:
City/Town:
Occupation:
Work Phone:
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How Long (Years):
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Bank Name:
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Bank Address:
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Accounts:
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I am applying for:
Heating Account
Equipment Lease
Equipment Rental
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Product:
Select Product
Furnace Oil
Propane
* Note: Cap Pricing Program is for Furnace Oil only.
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Number of tanks:
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Size(s):
(control click to select multiple)
455 litres/100 gallons
910 litres/200 gallons
1137 litres/250 gallons
374 litres/420 pounds
Tank Location:
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Furnace Age:
years
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Furnace Type:
Forced Warm Air
Hot Water
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Automatic Delivery:
Yes
No
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Building Size:
sq. feet
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Building Age:
years
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Number of Stories:
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Number of Rooms:
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Estimated Consumption:
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Alternative Heat Sources Being Used:
Electric
Wood
Other
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Hot Water Type:
Oil
Propane
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Water Heater:
Owned
Rented
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Are you interested in receiving an Irving Oil Credit Card?
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First Delivery Required:
Comments:
I hereby certify the above information to be true and complete. I authorize and consent to Irving Oil obtaining and exchanging credit information with any person or corporation with whom I have or propose to have financial relations.
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