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Retailer Application Form

Please ensure you complete all fields of information before submitting your applications. Failure to provide adequate information will delay our ability to process your application in a timely manner.


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 By checking the box, the Applicant confirms that it consents, or if the Applicant is a business, that the principal(s) and/or partner(s) of the Applicant consent, to the Supplier obtaining and using the credit and/or personal information of the Applicant, or any principals or partners of the Applicant, as may be required from time to time in connection with the credit applied for herein, or any renewal or extension thereof, and to the Supplier disclosing any such credit and/or personal information to any credit reporting agency, debt collection agency or to any commercial bank or other financial institution with whom the Applicant has financial relations in furtherance of the credit applied for herein. The Applicant also consents to the Supplier using and disclosing Applicant's information in connection with the promotion of Supplier's other products and services. The Supplier shall not sell the Applicant’s information without the Applicant’s prior written consent. The Applicant’s information will be held at the Supplier’s credit department, at the following address: #236, 4919 59th Street, Red Deer, Alberta, T4N 6C9, and will be accessible only to employees of the Supplier’s credit department. The Applicant may consult the Applicant’s information held by the Supplier and, if applicable, cause same to be rectified. For further information on the Supplier’s Privacy Policy or to withdraw its consent pursuant to this paragraph, the Applicant may contact the Supplier’s Privacy Officer via www.parkland.ca or call the Supplier at 1-800-662-7177 or if the Applicant requires a copy of the Supplier’s Privacy Policy, it may forward the request in writing to the Supplier to the attention of the Supplier’s Privacy Officer at the address indicated above.
 I understand and agree with the Parkland Fuel Corporation Privacy Policy and Terms of Use and consent to receiving electronic communications, including without limitation newsletters, promotions, updates and other materials, from Parkland Fuel Corporation; and I am aware that I can unsubscribe to receiving such communications at any time. Parkland Fuel Corporation can be reached at 333 96th Avenue N.E., 6302, Calgary, Alberta, T3K 0S3. Telephone: 403-567-2500.