544 Lincoln Street, Oxford, PA 19363 | 844-932-4104

25445 Commerce Lane, Chestertown, MD 21678 | 410-658-5502 | 410-778-0600

Credit App Residential

Please be sure to read the Terms and Conditions below before submitting this application.
* All Fields Required

About You:

Full Name:

Mailing Address:

City:

State & Zip Code:

Years There:

Do you own or rent? Own    Rent

Home Phone:

Fax:

Email: (optional)

Spouse Name: (optional)

Delivery Address: (If different than mailing)

City:

State & Zip Code:

Coupon Code:


About Your Work:

Employer:

Address:

City:

State & Zip Code:

Years there:

Business Phone:

Spouse's Employer: (optional)

Address: (optional)

City: (optional)

State & Zip Code: (optional)


Delivery & Burner Service:

Tank Size:

Last Year's Usage:
 gals.
Square Feet of House:

Number of Floors:

Number of Residents:

Method of Delivery:
 Automatic - preferred      Will Call
Tank Location: (facing house)

Last Delivery Date:

Gallons Delivered:

Domestic Hot Water Heated With:
 Fuel Oil
 Natural Gas
 Propane
 Electric
 Other
Previous Fuel Supplier: (optional)

Directions, House Description, Special Instructions to Add:


Optional:

I authorize you to charge my
credit card for the following services:
Fuel Oil Delivery
Burner Service
Budget Payment

Terms & Conditions:

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


Please check the box to verify:


      

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