HEATING & AIR CONDITIONING
Credit Account Application & Agreement
Mailing Address (if different from Delivery Address)
Nearest Cross Street________________________________________________________
What type of heat do you use? Heat #2 and/or Air or both. What is it for _____Heat____Heat/Hot
# of tanks ___________size_____________inside or outside______
age of tank _______amount in tank now __________
________Will call customer – I will call you when I need a delivery. I understand that an emergency fee and or furnace boiler start up fee may apply for emergency deliveries.
_______Automatic Delivery Customer – You may automatically deliver to my home to fill my tank. I will make payment within 20 days and agree to have a current credit card on file in the event the balance is not paid in full in 20 days, you may charge my credit card. As an automatic customer I understand that I will not be charged an emergency delivery fee should I run out of oil if my account balance is up to date. (Automatic Delivery must also complete the credit authorization form).
___I would like to schedule a fuel delivery: _______fill or ________150 gallons. (150 gal minimum)
___I would Like to be called to schedule an annual tune – up.
___I would like to be called to schedule service on my equipment, I am experiencing some problems.
Briefly Describe problem________________________________________________
_____I will give the delivery driver and/or the service technician a check, or credit card upon Delivery/service.
_____Please charge my credit card on file for deliveries/service. (Customer must complete the credit card authorization form).
Customer Signature Print name Date
Please Print & Sign as indicated – If you have Any questions – Please feel free to call.
945 East Street, Mansfield, MA 02048