FLYNN ENERGY & PROPANE RESIDENTIAL CREDIT APPLICATION

  • RESIDENTIAL CREDIT APPLICATION & AGREEMENT

  • SECTION 1

    FOR ALL ACCOUNTS COMPLETE THE FOLLOWING INFORMATION: 

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • DO YOU OWN OR RENT THIS LOCATION?*
  • CAN WE SIGN YOU UP FOR PAPERLESS BILLING?*
  • Are you applying for a Joint Account or Credit with a Co-Applicant?*

  • SECTION 2 

    ONLY COMPLETE FOR JOINT OR CO-APPLICANT ACCOUNTS: COMPLETE THE FOLLOWING INFORMATION ABOUT THE OTHER RESPONSIBLE PARTY

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • DO YOU OWN OR RENT THIS LOCATION?*

  •  ACCOUNT INFORMATION

    *PROPANE ACCOUNTS: Please Note that someone must be present at the time of installation

    *HEATING OIL ACCOUNTS: Please Note that a tank inspection must be performed by Flynn Energy representative prior to delivery

  • PRODUCTS USED

  • PROPANE TANK INFORMATION

  • IS DELIVERY ADDRESS THE SAME AS BILLING ADDRESS?*
  • DO YOU OWN OR RENT THIS LOCATION?*
  • Format: (000) 000-0000.
  • TYPE OF DWELLING*
  • IS FUEL USE TAX EXEMPT?*
  • PRODUCT USED FOR (MARK ALL THAT APPLY)*
  • DO YOU HAVE/USE A SECONDARY HEAT SOURCE (i.e. Burn Wood, Pellet Stove, Electric, etc)*
  • DO YOU HAVE A HEAT PUMP SYSTEM:*

  • HEATING OIL TANK INFORMATION

  • IS DELIVERY ADDRESS THE SAME AS BILLING ADDRESS?*
  • DO YOU OWN OR RENT THIS LOCATION?*
  • Format: (000) 000-0000.
  • TYPE OF DWELLING*
  • IS FUEL USE TAX EXEMPT?*
  • PRODUCT USED FOR (MARK ALL THAT APPLY)*
  • DO YOU HAVE/USE A SECONDARY HEAT SOURCE (i.e. Burn Wood, Pellet Stove, Electric, etc)*
  • DO YOU HAVE A HEAT PUMP SYSTEM:*
  • HOW DID YOU HEAR ABOUT US?*

  • 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.

  • Date*
     - -
  • Date*
     - -
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