About You:
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Full Name:
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Mailing Address:
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City:
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State & Zip Code:
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Years There:
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Do you own or rent?
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Own Rent
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Home Phone:
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Fax:
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Email:
(optional)
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Spouse Name:
(optional)
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Delivery Address:
(If different than mailing)
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City:
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State & Zip Code:
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Coupon Code:
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About Your Work:
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Employer:
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Address:
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City:
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State & Zip Code:
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Years there:
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Business Phone:
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Spouse's Employer:
(optional)
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Address:
(optional)
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City:
(optional)
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State & Zip Code:
(optional)
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Delivery & Burner Service:
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Tank Size:
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Last Year's Usage:
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gals.
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Square Feet of House:
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Number of Floors:
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Number of Residents:
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Method of Delivery:
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Automatic - preferred
Will Call
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Tank Location:
(facing house)
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Last Delivery Date:
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Gallons Delivered:
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Domestic Hot Water
Heated With:
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Fuel Oil
Natural Gas
Propane
Electric
Other
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Previous Fuel Supplier:
(optional)
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Directions,
House Description,
Special Instructions to Add:
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Above Ground Tank Inspection:
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All new customers with an aboveground tank are required to have a tank inspection no earlier than four (4) days after the submittal of this application. Please choose from the following dates to have one of our representatives perform this inspection. If you need to have your tank inspected prior to an available date shown here, please call our sales department at 800-486-5663.
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Date:
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Time:
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Optional:
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I authorize you to charge my
credit card for the following services:
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Fuel Oil Delivery
Burner Service
Budget Payment
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Terms & Conditions:
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By clicking on the submit button below, you verify that you have read and fully understand the Terms and Conditions of this agreement:
CREDIT TERMS: ACCOUNT BALANCES DUE IN FULL UPON RECEIPT OF INVOICE A finance charge will be assessed on balances over 30 days. This is computed by applying a periodic rate of 1½% per month (Annual Percentage Rate of 18%) on balances.Applicant agrees to pay cost of collection, including court costs and reasonable attorneys fee. Check returned because of insufficient funds, will be assessed a flat fee of $35.00
I/We authorize you or your designee to investigate the references and other data furnished by me/us or by any other person pertaining to my/our credit responsibility. I/We certify that the information on this application is true and correct and made for the purpose of obtaining credit both now and in the future.
I/We hereby jointly and severally agree to the terms and conditions on this agreement
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Please correctly type in the following phrase to verify:
Please type h.a.a.b in the box to the right.
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