Application Form - Permit to Sell - Ozone Depleting Substances and Other Halocarbons

PLEASE NOTE:

Permit Fees: 1 year - $25 / 2 years - $50
Payment options: Visa, Mastercard, American Express or debit card.
Please complete this form in its entirety. Incomplete applications will NOT be processed.
Please allow 2-3 weeks for delivery.

* Required fields

	Company Name:
*	Contact Name:
	Title:
	Mailing Address
*	Street/PO Box:
*	City, Town or Village:
*	Province:
*	Postal Code:
	Civic address
*	Street/PO Box:
*	City, Town or Village:
*	Province:
*	Phone:	-
	Fax:
	Language Preference:	English French
*	E-mail Address:

DETAILS OF PERMIT APPLICATION:

	* Please check one:	New Applicant or Renewal; provide permit number

	* Please check one	1 Year Permit ($25) or 2 Years Permit ($50)

	* How do you wish your permit to be issued?	Under Company's Name or Under my own name

DECLARATION

I hereby certify that the information provided above is true, complete, and accurate. I hereby authorize the Department of Environment to obtain or verify any information relevant to this application.


* Signature		* Date (yyyy/mm/dd)

NOTES: Under Section 23 of the Ozone Depleting Substances and Other Halocarbons Regulation, it is an offence to purchase, sell, supply or lease an ozone depleting substance or other halocarbons for the purposes of servicing equipment unless the vendor or purchaser, as the case may be, is in possession of a valid permit authorizing the purchase, sale, supply or lease. It is also an offence to sell, supply or lease an ozone depleting substance or other halocarbons to a person who does not have the required permit to purchase or otherwise receive the substance. For more information about the Ozone Depleting Substances and Other Halocarbons Regulation contact the New Brunswick Department of Environment, telephone: (506) 453-7945, fax: (506) 453-2390.

IF YOU HAVE ENTERED ALL RELEVANT INFORMATION, CLICK ON "ADD TO BASKET"

(ONLY ONCE) TO SUBMIT YOUR APPLICATION.

IF YOU WISH, PRINT A COPY FOR YOUR FILES USING YOUR BROWSER'S PRINT FUNCTION.