Eligibility verification | Ouellet Canada

ELIGIBILITY VERIFICATION FORM FOR HEATER COMPENSATION

INFORMATION ABOUT THE CLAIMANT
*First Name:
*Last Name:
Company name:
*Address:
*City:
*Province:
*Country:
*Postal Code:
*Phone:
*Email:
INFORMATION ABOUT THE PRODUCT
Name of store where the heater was purchased, if known:
City, if known:
*Model number:
Year of manufacture, if known:

Photo of the nameplate (manufacturing label of the heater):
(PDF / JPEG)

Sales invoice, showing the heater bought and purchase date:
(PDF / JPEG)

*Photo of the heater:
(PDF / JPEG)

I confirm that the information provided in this document is true and accurate, and I acknowledge that knowingly submitting a false claim may constitute civil or criminal fraud.

After checking the claim, we will confirm your eligibility by email, within three (3) business days of its receipt.

If you have any questions about this form, please call 1-800-463-7043, ext: 221 or email us at : [email protected]

Only one claim can be submitted per heater, subject to eligibility. Any additional claims for the same heater will be refused.