Commercial New Customer Agreement You are here: Home / Become A Customer / Commercial New Customer Agreement Commercial New Customer Agreement Company InformationName of Business*Address* PO Box or No. & Street City/Town State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Zip Company Website AddressType of Business*Tax I.D. Number*In Business Since* MM slash DD slash YYYY Legal Form Under Which Business Operates* Corporation Partnership Proprietorship If Division/Subsidiary, Name of Parent CompanyParent Company In Business Since MM slash DD slash YYYY Name of Company Principal Responsible for Business Transactions* First Middle Initial Last TitlePhone*Email* Name of Company Principal Responsible for Business Transactions First Middle Initial Last TitlePhoneEmail Bank ReferencesInstitution Name*Address*Account #*Phone*Second Institution NameAddressAccount #PhoneTrade ReferencesCompany Name #1*Contact Name*AddressPhone*Account Opened SinceCredit LimitCurrent BalanceCompany Name #2*Contact Name*AddressPhone*Account Opened SinceCredit LimitCurrent BalanceFuel InformationWhat products are you interested in (check all that apply): Fuel Oil Kerosene Clear Diesel Dyed Diesel Gasoline Propane Tank InformationFuel Oil, Kerosene, Diesel, and GasolineNotice: a required fuel tank inspection must be done before or at the time of the first delivery.Tank Size / Capacity*Tank Shape* Horizontal Vertical Inside Tank* Yes No Fill Pipe Location*Outside Tank* Yes No Outside Tank Location*PropanePropaneL/P Tank Percentage*L/P Tank Size / Capacity*Will we need to schedule an appointment to have Propane tanks set?* Yes No Delivery InformationDelivery Location Address*Tank Location on Property*Color of Building*Method of Delivery* AUTOMATIC WILL CALL 7 days notice required Would you prefer paperless billing? Yes No Do you want to set up Auto-Draft? Yes No Electronic Certification*Consent*I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. My submission of this form is my electronic signature and date of application. I/we agree to your Terms & Billing Agreement, and the above statement.* Related Pages FuelsServicesFuel Delivery InfoService PlansCooling Systems and EquipmentContact Us
