Commercial Application

This application is subject to credit check.


Your Information

*Name:
  Mr.     Ms.     Mrs.
Formerly:
Account #:
Company Name:
Chief Executive Officer:
Type of Business:
How Long in Business:
Billing Address:

Delivery Address:

Phone:
Work:
Other:
All deliveries will be C.O.D. until credit application is approved.
Commercial Credit Reference must include Name, Address and Telephone Number of each reference.
Commercial Credit Reference

Address:

Phone:
Address:

Phone:
Address:

Phone:
Previous Oil Supplier

Address:

Phone:
Housing
  Own
  Rent
Landlord's Address:

Landlord's Phone:
Delivery
  Fuel Oil Delivery
  Kerosene Delivery
Delivery Type
  Automatic Delivery
  Will Call Delivery
Diesel
  On Road Diesel (15PPM)
  Off Road Diesel (15 PPM)
Do You Use Fuel Oil To Heat Water For Domestic Use?
  Yes
  No
Maryland State Exemption Certificate Number (diesel users only):
Account Type:
  30 Day Account
  Budget Account
  C.O.D. Account
Payment is due upon receipt of invoice. Invoices not paid within 30 days are subject to 1.5% per month late fee until the account is paid in full. If the account is referred to a collection agency or an attorney for collection, I/We shall be responsible for the attorney's fees, collection agency fees plus any cost associated with collection.

All budget accounts must apply by Sept. 1 and include gallons used per year:

Please check the checkbox to verify: