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Application for Landfill Credit Account

Name of company/applicant:

If company, name of owner/president:

Names of persons permitted to charge to account:

Licence plates of vehicles on account:

Mailing address:

Telephone number:

Fax number:

Cell phone number:

Email address:

Applicant's signature

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Date

The personal information collected on this form is collected under the authority of the Municipal Act and will be used by the Municipality of Northern Bruce Peninsula to create record of Landfill Site Credit Accounts. Questions regarding the collection of personal information should be addressed to the Municipal Clerk at 56 Lindsay Road 5, Lion's Head, ON N0H 1W0 or by telephone at (519) 793-3522 ext. 236.

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Application for Landfill Credit Account

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