For Atlantic Used Oil Management Association usage only

Invoice: ___________________________________



GL # ________________   Date: _______________

HST (15%) _________________   

Sub-total: __________________
Total:  ______________________

Prepared by ________________________________

Signature __________________________________

Make sure you have all the waybills left behind by your collector upon collection of your used FILTERS because you will be required to attach them to the following form. 

For collection facilities that use drums or wheeled bins to accumulate FILTERS, the amount for which you are entitled is: $20$ per 205L drum -- 28$ per 240L bin -- 34$ per 360L bin.

 

To receive payment via electronic funds transfer, please attach a copy of your void cheque to this form.

I, {personneContact}, {title}, confirm the information provided on this form is accurate and I recognize it could be subject to audits. The detailed files supporting this claim are available for consultation upon request. I certify that, from the best of my knowledge, the used products listed in the current claim were generated in New-Brunswick.

Atlantic Used Oil Management Association NB HST # 83003 5432 RT 0001