Account Application
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Account Application

Account Application

Consolidated Account Application

Please complete the application form below and submit to apply for a residential or commercial account with County Farm Centre.

Residential or Commercial Account

What type of account are you applying for?

Apply for a Residential account if you are seeking home heating. Apply for a Commercial account if you are operating as a business or operating under a registered business name.

Products

What products are you interested in?

Applicant - Full Legal Name

Is this a joint application?

Co-applicant - Full Legal Name

Billing Address

Use format R7R 7R7 (letter, number, letter, ...)

Delivery Address

Own/Rent
Use format R7R 7R7 (letter, number, letter, ...)
How long have you lived at this address?

Previous Address

Use format R7R 7R7 (letter, number, letter, ...)

Business Identification

Identity *

Business Address - Physical

Is delivery address of fuel different than this Business Address?
My business mailing address is the same as the physical address

Fuel Delivery Address

Business Address - Mailing

Additional Contact Info

Your invoices, payment receipts, and monthly statement will be sent by email to this address.

Land & Equipment

Land & Buildings *
Equipment *

Officers/Partners

plus1 Add Another minus1 Remove
 

* You must have at least one Officer.

Propane Tank & Appliance Information

Have you purchased a home that County Farm Centre currently supplies with Propane?

Oil Tank & Appliance Information

Have you purchased a home that County Farm Centre currently supplies Furnace Oil?
I have an
*Inspection has been completed by a licensed technician holding certification under TSSA Fuel Oil Regulation 213/01 within 12 months.

Maximum file size: 16.78MB

Employment

Employment (Co-applicant)

Financial Info

If requested, would you be able to provide recent financial statements?

Financing

Do you require financing?
Our financing expert will contact you with details on our Agri-Finance Program

References

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* You must have at least one Reference.

Requested Credit: Propane

Requested Credit: Heating Oil

Requested Credit: Dieselex Gold

Requested Credit: Agronomy

Requested Credit: Retail

Payment Options

These are the available methods to pay your commercial account:

  • Automatic withdrawal from bank
  • Online banking
  • Electronic Funds Transfer (EFT)
  • Email Money Transfer (EMT)
  • Cheque
  • In-person at one of our locations
Do you wish to sign up for equal payments plan?
We will contact you to set up a payment plan.

Pre-Authorized Payment

Choose the method of pre-authorized payment
For your security, please provide a phone number you can be reached at, and we will contact you to obtain your credit card information.
I authorize County Farm Centre to pay my account balance using the above mentioned account as per the above payment options.
I authorize County Farm Centre, and the financial institution designated (or any other financial institution I may authorize at any time) to begin deductions as per my/our instructions for monthly regular reoccurring payments of all charges arising under my/our County Farm Centre account(s). I authorize the balance owing on my/our County Farm Centre account statement to be:

  • Withdrawn from my bank account on the 20th of the month

This authority is to remain in effect until County Farm Centre has received written notification from me/us of its change or termination. This notification must be below. I may obtain a sample cancellation form, or more information on my/our right to cancel a Pre-Authorized Payment (PAP) Agreement at my/our financial institution or by visiting www.payments.ca.

County Farm Centre may not assign this authorization, whether directly, by operation of law, change of control or otherwise, without providing at least ten (10) days prior written notice to me/us.

I have certain recourse rights if any payment does not comply with this agreement. For example, I have the right to receive reimbursement for any PAP that is not authorized, or is not consistent with this PAP Agreement. To obtain a form for a Reimbursement Claim, or for more information on my/our recourse rights, I may contact my/our financial institution or visit www.payments.ca.

THE UNDERSIGNED ALSO UNDERSTANDS THAT ALL PURCHASES ARE DUE AND PAYABLE IN FULL NO LATER THAN THE 20TH OF THE MONTH FOLLOWING PURCHASE.

THE UNDERSIGNED CERTIFIES THE ABOVE INFORMATION TO BE TRUE AND AFFIRMS THAT ANY CREDIT GIVEN TO ME IS EXTENDED ON THE BASIS OF SUCH INFORMATION.

The undersigned consents to the obtaining of credit and / or personal information as may be required at any time in connection with the credit hereby applied for or any renewal or extension thereof and to the disclosure of any credit information concerning the undersigned to any credit reporting agency or to any person with whom the undersigned has or proposes to have financial relations.

THE UNDERSIGNED FURTHER ACKNOWLEDGES THAT I HAVE BEEN INFORMED OF YOUR PREVAILING TERMS FOR REPAYMENT AND AGREE TO PAY AN INTEREST CHARGE OF 2% PER MONTH (24% PER ANNUM) ON ANY OVERDUE BALANCE UNTIL PAID.

Authorization

I agree to a Credit Check
If you decline a credit check you will be required to prepay for products and services.
Please confirm you do not require credit
If you decline a credit check you will be required to prepay for products and services.
I agree to the Terms of Use and have read the Privacy Policy
I have read and accept the terms in the Account Agreement