2018 Fuel Refund Application
Application for former electric utility customers to obtain their fuel refund (if eligible)
Last Name on Account *
Your answer
First Name on Account *
Your answer
Telephone Number (primary) *
Your answer
Telephone Number (secondary)
Your answer
Email Address
Your answer
What is your former account information
Account Number
Your answer
Electric Service Address (civic address) *
Your answer
If you are eligible, where would you like us to send the refund
Street Address *
Your answer
Apartment/Unit Number
Your answer
City *
Your answer
Province/State *
Your answer
Country *
Your answer
Postal/Zip Code *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Town of Antigonish. Report Abuse - Terms of Service