Market Price Contract

MARKET PRICE PROGRAMS
ACCOUNT NUMBER (EXISTING CUSTOMERS)
APPLICANT CONTACT INFORMATION*

First NameMiddle NameLast NameSuffix
COAPPLICANT CONTACT INFORMATION

First NameMiddle NameLast NameSuffix
BILLING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your Delivery Address the same as your Billing Address?

YESNo (please add below)
DELIVERY ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HOME PHONE NUMBER*

Area CodePhone Number
CELL PHONE NUMBER

Area CodePhone Number
EMAIL*
example@example.com
DESIRED PROGRAM (MUST SELECT ONE)*

OIL BUDGET PLAN -- $ CURRENT MARKET PRICEOIL 10-DAY PLAN* -- $ CURRENT MARKET PRICE
ARE YOU A SENIOR CITIZEN? (65+ -$0.02 PER GALLON DISCOUNT)

YESNO
*COMPLETED & APPROVED CREDIT APPLICATION MUST BE ON FILE.
ADDITIONAL CUSTOMER INFORMATION
NUMBER OF GALLONS TO RESERVE FOR THE SEASON?
IMPORTANT: Please do not underestimate as any gallons used over reserved amount will be billed at market rate.
DELIVERY METHOD PREFERENCE

AUTOMATICWILL CALL
IMPORTANT: Choose 'A' or 'B' below BUT NOT BOTH.
A. AUTOMATICALLY CHARGE MY CREDIT CARD FOR OIL/BUDGET PAYMENTS. ($0.05 per gallon credit card convenience fee will be added)

YESNO
B. AUTOMATICALLY DRAFT MY MONTHLY BUDGET PAYMENT FROM MY CHECKING OR SAVINGS ACCOUNT. (Please contact the office for the E-Check or ACH form. A completed & approved form must be on file)

YESNO
PLEASE ADD THE COST OF ALL SERVICE CONTRACTS TO MONTHLY BUDGET PLAN.

YESNO
IF I AM THE LANDLORD, THE TENANT HAS MY PERMISSION TO CALL CHESTER COUNTY FUEL OIL FOR SERVICE AS NEEDED.

YESNO
I CURRENTLY HAVE

FURNACEBOILEROIL H/W HEATERCENTRAL AIR-CONDITIONING
TANK SIZE

275 (STANDARD)NOT SUREOTHER SIZE
RESIDENCE INFORMATION

I OWN & RESIDE IN THE HOMEI RENT THE HOME FROM SOMEONE ELSEI'M THE LANDLORD AND RENT OUT THE PROPERTY TO TENANT
LOCATION OF FILL SPOUT?
TANK LOCATION?
ANY ADDITIONAL DETAILS?
Applicant's Electronic Signature (Type Name)*
Co-Applicant's Electronic Signature (Type Name)
Should be Empty:

MARKET PRICE PROGRAMS

ADDITIONAL CUSTOMER INFORMATION