NB-Membership application form

Address *

From the list of applicable products below, select the ones for which you are registering. *

Lubricating oils covered by the regulation Containers of 50L or less (total capacity) Filters of less than 8 inches/203 mm in length Filters of 8 inches/203 mm or more in length Sump type automatic transmission filter Aerosol containers (units) Antifreeze mix Antifreeze concentrate Antifreeze containers of 50L or less

Please indicate your estimated annual volume for the upcoming year for each of the following products.
Lubricating oils *
Containers of 50L or less *
Filters of less than 8 inches/203 mm in length *
Filters of 8 inches/203 mm or more in length *
Sump type automatic transmission filter *
Aerosol containers (units) *
Antifreeze mix *
Antifreeze concentrate *
Antifreeze containers of 50L or less *

There is a $200 (plus applicable taxes) UOMA NB membership fee, and the payment is mandatory in order for your registration to be completed. How will you proceed for the payment of the membership application fee? *

Sending a check for the total amount (including taxes) to UOMA NB Electronic funds transfer for the total amount (including taxes)
Here is the UOMA NB information you will need in order to make the payment.
HST #: 83003 5432 RT 0001
Address: UOMA NB, #214 - 1101 Brassard Blvd, Chambly, QC, J3L 5R4
**Please address your check to UOMA NB**
Should be Empty:

NB - Membership application form