Nova Scotia-Membership application form

Membership application form

Nova Scotia
Company name*
Address*

Street Address

Street Address (Line 2)

CityProvince / State

Postal / Zip Code
Phone Number*

Area CodePhone Number
Fax Number

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

Area CodePhone Number
Accounting Fax Number

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

Please provide the following information and/or documentation.
Since when does your company distribute products managed by the Atlantic Used Oil Management Association?*
Attach a signed copy of your membership agreement*

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Lubricating oils covered by the regulationOil containers of 50L or lessFilters of less than 8 inches/203 mm in lengthFilters of 8 inches/203 mm or more in lengthAerosol containers (lubricants and cleaners for automotive parts)Glycols (antifreezes) mixGlycols (antifreezes) concentrateGlycols (antifreezes) containers of 50L or lessDiesel exhaust fluid containers of 50L or less

Please indicate your estimated annual volume for the upcoming year for each of the following products.
Lubricating oils*
Oil containers of 50L or less*
Filters of less than 8 inches/203 mm in length*
Filters of 8 inches/203 mm or more in length*
Aerosols (units)*
Glycols (antifreezes) mix*
Glycols (antifreezes) concentrate*
Glycol (antifreeze) containers of 50L or less*
Diesel exhaust fluid containers of 50L or less*

Sending a check for the total amount (including taxes) to the Atlantic Used Oil Management AssociationElectronic funds transfer for the total amount (including taxes)
Here is the Atlantic Used Oil Management Association information you will need in order to make the payment.
HST #: 830035432RT0004
Address: Atlantic Used Oil Management Assocciation, #204 - 248 Fréchette Blvd, Chambly, QC, J3L 2Z5
**Please address check to UOMA NS**
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