FUELNet™ Online Application

All entry fields labeled with an asterisk * are required in order to submit your FUELNet™ application.
Please include as much detail as possible to ensure prompt processing of your application.

All information supplied by the applicant will be securely transmitted.

Applicant Information

Name *

Date of Birth

SIN

Address *

City *

Province *

Postal Code *

Telephone *

Cell Phone

Fax

E-mail Address *

Amount of Credit Requested *

Name as it will appear on Card *

Number of Additional Cards Required *

I do not require additional cards

I require additional cards under the same name

I require additional cards under different names

Total Number of Cards Required *

Total Number of Cards With Different Names Required *

For quantities of cards with different names greater than 10, please enter the first 10 names and our Credit department will contact you for further information.

Type of Business

Contact

Co-applicant Information

Co-applicant (spouse, owners, partners, or company officers)

Name

Home Address

City

Province

Postal Code

Date of Birth

S.I.N.

Trade References

Present Fuel Company Supplier

Present Fuel Supplier Name

Address

City

Province

Postal Code

Telephone

Other Supplier

Other Supplier Name

Telephone

Other Supplier

Other Supplier Name

Telephone

Authorization

I agree to the Terms of Use and have read the Privacy Policy *

I have read and accept the terms in the Cardholder Agreement *

Note: Note:

After submitting your online application, please print and fill out the Bank Information Release Form. You may mail, fax, or email it to us at:

UPI Energy FS
105 Silvercreek Parkway North, Suite 200
Guelph, ON N1H 8M1
Fax: 519-821-2618
Email: credit@upi.on.ca

FUELNet™ Online Application

Note: Note:

About Us

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FUELNet Application

FUELNet™ Online Application

Note: Note:

About Us

Customer Care

Products

Programs

Opportunities

Promotions