Atlantic used oil management association-Membership application form

Membership application form
Important: You are required to register as a member with each provincial program whose jurisdiction you will sell and/or distribute regulated products in. Note: a separate provincial membership agreement is required for each registration. You can find each provincial agreement at the following links: NB, NL, NS, PE.

Also note you'll have the opportunity to provide feedback or precisions related to this form and your answers within via a dedicated space at the end of the form.
Company name*
Address*

Street Address

Street Address (Line 2)

CityProvince / State

Postal / Zip Code
Company Phone Number*

Area CodePhone Number
Extension
Contact name*
Contact email*
example@example.com
Contact direct phone number

Area CodePhone Number
Extension
Accounting contact name (if different)
Accounting contact email (if different)
example@example.com
Accounting Phone Number (if different)

Area CodePhone Number
Extension

Which of the following provinces is/will your company distributing Atlantic Used Oil Management Association products in?*

New BrunswickNewfoundland & LabradorNova ScotiaPrince Edward Island

When did your company begin distributing regulated products in New Brunswick?*
Please provide your Recycle NB registration number*
Attach a signed copy of your NB membership agreement.*

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When did your company begin distributing regulated products in Newfoundland & Labrador?*
Attach a signed copy of your NL membership agreement.*

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When did your company begin distributing regulated products in Nova Scotia?*
Attach a signed copy of your NS membership agreement.*

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When did your company begin distributing regulated products in Prince Edward Island?*
Attach a signed copy of your PE membership agreement.*

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Please indicate your estimated annual volume for each product you've indicated having the intention of selling in each given province.
New Brunswick
Lubricating oil - NB*
Oil containers of 50L or less - NB*
Filters of less than 8 inches/203 mm in length - NB*
Filters of 8 inches/203 mm or more in length - NB*
Sump type automatic transmission filter - NB*
Aerosol containers (lubricants and break cleaners) - NB*
Antifreeze mix - NB*
Antifreeze concentrate - NB*
Antifreeze containers of 50L or less - NB*
Newfoundland & Labrador
Lubricating oil - NL*
Oil containers of 50L or less - NL*
Filters of less than 8 inches/203 mm in length - NL*
Filters of 8 inches/203 mm or more in length - NL*
Sump type automatic transmission filter - NL*
Aerosol containers (lubricants and break cleaners) - NL*
Antifreeze mix - NL*
Antifreeze concentrate - NL*
Antifreeze containers of 50L or less - NL*
Nova Scotia
Lubricating oil - NS*
Oil containers of 50L or less - NS*
Filters of less than 8 inches/203 mm in length - NS*
Filters of 8 inches/203 mm or more in length - NS*
Sump type automatic transmission filters - NS*
Aerosol containers (lubricants and automotive parts cleaners) - NS*
Antifreeze mix - NS*
Antifreeze concentrate - NS*
Antifreeze containers of 50L or less - NS*
Diesel exhaust fluid containers of 50L or less - NS*
Prince Edward Island
Lubricating oil - PE*
Oil containers of 50L or less - PE*
Filters of less than 8 inches/203 mm in length - PE*
Filters of 8 inches/203 mm or more in length - PE*
Sump type automatic transmission filter - PE*
Aerosol containers (lubricants and automotive parts cleaners) - PE*
Antifreeze mix - PE*
Antifreeze concentrate - PE*
Antifreeze containers of 50L or less - PE*
Diesel exhaust fluid containers of 50L or less - PE*

If you wish to provide feedback regarding the form or precisions regarding your answers therein, please do so below.
Signature*

Clear
Date*

MonthDayYear
Date
Please note there is a $230 (tax included) registration fee per province payable upon reception of invoice.
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