FLYNN ENERGY & PROPANE RESIDENTIAL CREDIT APPLICATION

RESIDENTIAL CREDIT APPLICATION & AGREEMENT
SECTION 1

FOR ALL ACCOUNTS COMPLETE THE FOLLOWING INFORMATION:
NAME*
EMAIL ADDRESS*
HOME PHONE
Format: (000) 000-0000.
CELL PHONE*
Format: (000) 000-0000.
CURRENT EMPLOYER*
HOW LONG HAVE YOU BEEN WITH THIS EMPLOYER*
i.e. 3 years or 6 months
BILLING ADDRESS*

BILLING ADDRESS

Street Address Line 2

CITYSTATE

ZIP
COUNTY*
HOW LONG AT THIS ADDRESS*
i.e. 3 years or 6 months
OWNRENT
YESNO
Yes - Applicant and Co-Applicant share the same AddressYes - Applicant and Co-Applicant do not share the same AddressNO CO-APPLICANT

SECTION 2

ONLY COMPLETE FOR JOINT OR CO-APPLICANT ACCOUNTS: COMPLETE THE FOLLOWING INFORMATION ABOUT THE OTHER RESPONSIBLE PARTY
NAME*
EMAIL ADDRESS*
HOME PHONE
Format: (000) 000-0000.
CELL PHONE*
Format: (000) 000-0000.
CURRENT EMPLOYER*
HOW LONG HAVE YOU BEEN WITH THIS EMPLOYER*
i.e. 3 years or 6 months
CO-APPLICANT ADDRESS IF DIFFERENT FROM APPLICANT'S ADDRESS ABOVE*

BILLING ADDRESS

Street Address Line 2

CITYSTATE

ZIP
HOW LONG AT THIS ADDRESS*
i.e. 3 years or 6 months
OWNRENT
RELATIONSHIP TO APPLICANT*

ACKNOWLEDGEMENT

THE UNDERSIGNED ENTERS INTO THIS RESIDENTIAL CREDIT APPLICATION AND AGREEMENT WITH FLYNN ENERGY TRANSPORT, INC. (“FET”) TO EXTEND CREDIT TO THE APPLICANT(S) SIGNED BELOW AND FOR THE PURPOSES OF OBTAINING AND MAINTAINING A FUEL AND SERVICES ACCOUNT WITH FET UPON THE TERMS AND CONDITIONS AGREED TO HERE TO WHICH ARE HEREBY INCORPORATED BY REFERENCE. THE UNDERSIGNED FURTHER REPRESENTS AND WARRANTS THE ACCURACY AND COMPLETENESS OF ALL INFORMATION PROVIDED TO FET IN THE SECTIONS ABOVE AND ACKNOWLEDGES THAT FET WILL BE RELYING ON THIS INFORMATION. THE UNDERSIGNED AGREES AND ACKNOWLEDGES THAT (I) THEY HAVE READ AND AGREE TO THE TERMS AND CONDITIONS ATTACHED HERETO; (II) TO MAKE PAYMENT IN FULL TO FET FOR ALL AMOUNTS DUE IN ACCORDANCE WITH THEIR PAYMENT TERMS; AND (III)TO PAY ALL CHARGES ASSOCIATED WITH LATE PAYMENT OR COLLECTION INCLUDING BUT NOT LIMITED TO: SHERRIFF'S FEES, COURT COSTS, AND ATTORNEY FEES. THE UNDERSIGNED ACKNOWLEDGES RECEIPT OF (I) FET'S TERMS AND CONDITIONS; AND (II) THE PROPANE SAFETY AND IMPORTANT HOMEOWNER SAFETY TIPS LITERATURE PROVIDED BY FET, BOTH OF WHICH ARE ATTACHED HERETO. THE FURNISHING OF THIS FORM OF RESIDENTIAL CREDIT APPLICATION AND AGREEMENT DOES NOT CONSTITUTE AN OFFER OR OTHER BINDING AGREEMENT OF FET. THIS AGREEMENT SHALL BE BINDING UPON THE PARTIES HERETO ONLY WHEN SIGNED AND DELIVERED BY BOTH THE UNDERSIGNED AND AUTHROIZED REPRSENTATIVE OF FET. THE UNDERSIGNED HAVE EXECUTED THIS RESIDENTIAL CREDIT APPLICATION AND AGREEMENT AS OF THE DATE SET FORTH BELOW.
Signature*
Date*

MonthDayYear
Date
Social Security Number*
Co-Applicant Signature
Date*

MonthDayYear
Date
Social Security Number
Should be Empty:

RESIDENTIAL CREDIT APPLICATION & AGREEMENT