Western Petroleum

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Become A Customer

New Account Application

Western Petroleum appreciates each and every one of our customers and we welcome new customers to join our family.


Account Type

Title
First Name:
Last Name:
Company Name:
Email:
Street Address:
City / Town:
Province:
Postal Code
Telephone:
Mobile:
Fax:

Billing Address (if different than above)


Address:
City / Town:
Province:
Postal Code

Existing Customer?
Best time to Call?
Delivery Type?
Fuel Type?
Tank Location?
Is Your Tank Government Certified?
If Certified, Please provide	Host #
	Expiry #

Age of Tank?

First Delivery?	The date the first delivery is required by, MM/DD/YYYY

Average Annual Consumption?


Automatic Visa Payment?

Budget Plan?

I hereby certify the above information to be true and complete. I authorize and consent to Western Petroleum obtaining and exchanging credit information with any person or corporation with whom I have or propose to have financial relations. I Accept Signature: (your name here constitutes signature)

Credit Applications

To set up an account with Western Petroleum, please complete the online form below. If you prefer, you can print, complete and fax/mail the following PDF credit application form. Be sure to indicate whether it is for a Personal Account or a Commercial Account. One of our representatives will follow up with you once we receive the application.

- Personal Credit Application

- Commercial Credit Application

Please fax completed forms to 709.643.9396

or mail to:

Western Petroleum
1 Main Street
Stephenville, NL, A2N 2Y9