301-725-5550 |
301-776-7550

Residential Application

This application is subject to credit check.


Your Information

*Name:
   Mr.      Ms.      Mrs.
Formerly:
Account #:
Social Security #:
Driver's License #:
Spouse Name:
   Mr.      Ms.      Mrs.
Spouse
Social Security #:
Spouse
Driver's License #:
Billing Address:

Delivery Address:

Phone:
Work:
Other:
Employment Information

Address:

Phone:
Address:

Phone:
Address:

Phone:
Housing
  Own
  Rent
Landlord's Address:

Landlord's Phone:
Delivery
  Fuel Oil Delivery
  Kerosene Delivery
Delivery Type
  Automatic Delivery
  Will Call Delivery
Account Type
  30 Day Account
  Budget Account
  C.O.D. Account
Do You Use Fuel Oil To Heat Water For Domestic Use?
  Yes
  No
All budget accounts MUST apply by September 1st and include gallons used per year.

All deliveries will be C.O.D. until credit application is approved. 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 costs associated with collection.

Please correctly type in the following phrase to verify: