Purchaser's Permit Application

The personal information on this form is being collected under the authority of the Gasoline & Motive Fuel Tax Act. The information will be used for licensing purposes and for necessary administration of the licence. If you have any questions regarding the collection and use of this information, please contact the Manager Program Services, Department of Finance, P. O. Box 3000, Fredericton, NB E3B 5G5. Telephone: 1-800- 669-7070 or e-mail wwwfin@gnb.ca.
* Required fields
* Part 1 - Applicant Information
* Legal Name
* Business or Trade Name
* Business Number  
* Preferred Language?
* Purchaser's Permit Type
* Application Type
Please indicate licence #  
Sole Proprietorship (one owner)
Two or more persons - PARTNERSHIP NAME must be registered with the Corporate Affairs Branch of Service New Brunswick (506) 453-2703. List name of address and partners.
Limited or incorporated company with directors and officers and must be registered with Corporate Affairs Branch of Service New Brunswick (506) 453-2703. List name and address of directors and officers.
Mailing Address:
* Postal Code:
* Civic Number:
P.O. Box:
* Street Name:
* Street Type:
* Community:
* Province:
* Country:
* Daytime Telephone: Example: (506)555-1234
Fax: Example: (506)555-1234
Email Address:
Physical Location of Business:
* Postal Code:
* Civic Number:
P.O. Box:
* Street Name:
* Street Type:
* Community:
* Province:
* Country:
* Daytime Telephone: Example: (506)555-1234
* Fax: Example: (506)555-1234
Contact Person:
(You or your representative if you are not available during the day)
* Contact Name:
* Daytime Telephone: Example: (506)555-1234
* Fax: Example: (506)555-1234
* Email Address:


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