F.o.t. Application 2 Fuel Oil Tax Act Form Page 2
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2VENDOR PERMIT APPLICATION - PAGE 2
1. Have you ever had a Yukon Fuel Vendor’s permit before? yes no
If yes, under what name and what location?_______________________________________________________
__________________________________________________________________________________________
Do you still require this permit? yes no
2. Please give your operating name if it is different from your business name.
___________________________________________________________________________________________
3. What is your operating season? from ________________________ to _____________________________
4. Who is your major supplier? ___________________________________________________________________
Are you under contract with them? yes no
Do you hold their fuel on consignment? yes no
5. Which trucking company transports your fuel for you? ________________________________________________
___________________________________________________________________________________________
6. How are fuel deliveries verified? _________________________________________________________________
___________________________________________________________________________________________
7. Do you also sell tobacco products at this place of business? yes no
If yes, what is your Tobacco Retailer’s Permit Number? _______________________________________________
8. Do you sell heating fuel? yes no
If yes, do you deliver? yes no
9. Please give the name and number of the person to contact in case of inquiries.
Name ______________________________________________________________________________________
Phone __________________________ Fax ________________________ Email __________________________
For Department Use Only
Permit No. ___________________ Date Issued _______________________
Authorized
(for initial) _______________________________________________________________________
The personal information requested on this form is collected under the authority of and used for the purpose of administering the Fuel Oil Tax Act.
Questions about the collection or use of this information can be directed to the Yukon Department of Finance, Box 2703, Whitehorse, Yukon, Y1A 2C6,
(867) 667-5343.
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