Personal information about the participant Information about the address where the equipment will be installed Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon I would like a* -Choose an option-Extension shower kitFixed shower kit I confirm that my water heater runs on natural gas I agree to pay $5 to have the kit delivered (will be billed by Gazifère after the kit is delivered) I agree to install the items in the kit (a shower head fixed or extension – according to your preference, a control valve, a kitchen aerator and a bathroom one, two Leak Detection Tablets for the Toilet, as well as teflon tape) within 30 days after delivery I understand that the personal information provided when filling out the online form is only used and necessary to receive Gazifère’s services, to participate in the programs, or to respond to my enquiry, and in accordance to Gazifère’s privacy policy. 42358
