Fillable Form 1: APPLICATION FOR RENEWAL OF PETROLEUM PRODUCTS (Prince Edward Island Regulatory & Appeals Commission)

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Form 1: APPLICATION FOR RENEWAL OF PETROLEUM PRODUCTS (Prince Edward Island Regulatory & Appeals Commission)

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APPLICATION FOR RENEWAL OF PETROLEUM PRODUCTS WHOLESALE DISTRIBUTION LICENSE
1
CORPORATE NAME OF WHOLESALER:
2
DOING BUSINESS AS (IF DIFFERENT FROM ABOVE):
3
ADDRESS:
Street
Town, Community
Province Postal Code Telephone
4
COMPLETED BY:
FULL NAME (please print):
SIGNATURE:
TITLE:
TELEPHONE:
EMAIL:
DATE:
5
RETURN COMPLETED FORM TO:
ISLAND REGULATORY AND APPEALS COMMISSION
134 KENT STREET, P. O. BOX 577
CHARLOTTETOWN, PE
C1A 7L1
TEL: 902-892-3501
TOLL FREE (NS & PEI): 1-800-501-6268
FAX: 902-566-4076
LICENSE FEES PAYABLE TO “ISLAND REGULATORY AND APPEALS COMMISSION”
Information on this Form is collected pursuant to the Petroleum Products Act and will be used by the Commission in the administration of the said
Act. For additional information, contact the Commission at 902-892-3501 or by email at info@irac.pe.ca.
IRAC515(2019)
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Form 1: APPLICATION FOR RENEWAL OF PETROLEUM PRODUCTS (Prince Edward Island Regulatory & Appeals Commission)

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Completed 24 July 2021

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