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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
Old Credit Application Form
CONTACT INFORMATION
Title
Name
First
Last
Phone
Fax
Email
Address
City
Province
Postal Code
ADDITIONAL INFORMATION
Delivery Address
City
Province
Postal Code
Rent or Own?
Rent
Own
Age of Furnace
Water Heater
Forced Air / Hot Water
Tank Location
Previous Year Consumption
Payment Method
Automatic Delivery
Yes
No
Furnace Insurance
Yes
No
Employer
Number of years
Date of Birth
MM slash DD slash YYYY
Other
AGREEMENT
THE APPLICANT AGREES TO THE ABOVE STATED TERMS AND AGREES TO PAY INTEREST ON ALL INVOICES EXCEEDING OUR TERMS OF SALES WHICH ARE SUBJECT TO A 2% INTEREST CHARGE PER MONTH (24% PANNUM). I ACCEPT YOUR OFFER TO SUPPLY MY ENTIRE REQUIREMENTS OF HOME HEATING OIL AND AGREE TO MAKE PAYMENT WITHIN THE TERMS OF OUR CONTRACT. I ALSO AGREE THAT GREEN COAST ENERGY MAY OBTAIN A CONSUMER CREDIT REPORT FROM A REPORTING AGENCY AND MAY EXCHANGE SUCH CREDIT INFORMATION. GREEN COAST ENERGY RESERVES THE RIGHT TO LIMIT OR WITHDRAW CREDIT AT ANY TIME ITS DISCRETION AND TO ALTER THE RATE OF CREDIT PAYABLE ON UNPAID BALANCES.
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