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Moncton: 132 Beaverbrook Street | Saint John: 201 Broad Street
Moncton:
506.855.8500
| St John:
506.635.8800
Mon – Fri: 8 AM – 5 PM
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Green Coast Energy
Energy efficient heating needs
Home
Services
Become A Customer
Contact
Moncton Office
Saint John Office
Home
Services
Become A Customer
Contact
Moncton Office
Saint John Office
Become A Customer
Name
(Required)
First
Last
Email
(Required)
Home Phone
(Required)
Cell Phone
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Ownership of Property
(Required)
Owns residence with mortgage
Owns residence outright
Rents residence
Mortgage Company's / Bank's Name
Mortgage Company's / Bank's Address (include City / Town / Post Office)
Home Owner's Name
(Required)
Home Owner's Address (include City / Town / Post Office)
(Required)
e-Billing
(Required)
Yes, please sign me up for e-billing
No, please deliver my bill by mail
Delivery Address
(Required)
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Years at this Address
(Required)
Previous Address (if at present address less than 2 years)
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Years at this Address
Is your mailing address the same as your delivery address?
(Required)
Yes
No
Mailing Address
(Required)
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Current Employment Information
Occupation
(Required)
Employer's Name
(Required)
Employer's Address
(Required)
Employer's Phone Number
(Required)
Years of Service with Employer
(Required)
Previous Employment (if above is less than 2 years of service)
Previous Occupation
Previous Employer's Name
Previous Employer's Address
Previous Employer's Phone Number
Years of Service with Previous Employer
Marital Status
(Required)
Single
Married
Other
Do you have a co-applicant? (Partner/Spouse)
(Required)
Yes
No
Partner's Name
(Required)
First
Last
Partner's Date of Birth
(Required)
MM slash DD slash YYYY
Partner's Current Employment
Partner's Occupation
(Required)
Partner's Employer's Name
(Required)
Partner's Employer's Address
(Required)
Partner's Employer's Phone Number
(Required)
Partner's Years of Service with Employer
(Required)
Product Needed (Check all that apply)
(Required)
Furnace Oil
Propane
Diesel
Thermaclean
I'm not sure
Estimated Annual Volume
If unsure, leave blank
Former Fuel Supplier
Heating Equipment (Check all that apply)
(Required)
Furnace
Boiler
I'm not sure
Hot Water Heated By (Check all that apply)
(Required)
First Choice
Second Choice
Third Choice
Hot Water Heated By (Check all that apply)
(Required)
Oil
Propane
Electricity
I'm not sure
Secondary Heat Source (Check all that apply)
(Required)
Propane or Gas Fireplace
Wood or Pellet Heating
Baseboard Heating
Other/I'm not sure
None
Tank Location
(Required)
Inside
Outside
I'm not sure
Does Your Tank Have a Vent Alarm Installed
(Required)
Yes
No
I'm not sure
Service Delivery Type
(Required)
Automatic - Worry-free automatic delivery. We calculated when you need deliveries
Call In - Call us when you need a delivery
I'm not sure
Delivery Start Date
(Required)
MM slash DD slash YYYY
Service Plans
(Required)
Annual Tune-Up (from $109/year)
Parts Protection and Service Plan ($179/year)
Premium Parts Protection and Service Plan ($229/year)
I want to learn more
No service plan
Payment Plans
(Required)
Budget Payment Plan - Distribute heating costs over 10-12 equal monthly payments
Pre-Authorized Balance Plan - Monthly statement amount owing is drawn automatically from your bank account
I want to learn more
No payment plan
If you have any comments, questions or special delivery instructions, please state in the box below or email our office via the Contact page.
Terms of Agreement
(Required)
I agree to the Green Coast Energy Energy terms.
Checking the box above implies that you have read and agree to the Green Coast Energy terms stated below.
Credit Check Approval
(Required)
I agree to the credit check.
Checking the box above implies that you agree to permit Green Coast Energy to check your credit history.
Email Approval
I agree to receive occasional e-mails with deals & offers from Green Coast Energy Inc.
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