Your Information: |
*Name:
(First, MI, Last)
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Mr. Ms. Mrs.
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Date of Birth:
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*Billing Address:
(City, State, ZIP)
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*Delivery Address:
(City, State, ZIP)
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Own or Rent?
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Own
Rent
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Years at Address
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Previous Oil User?
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Yes No
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Previous / Current Oil Supplier
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*Phone:
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() -
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Work:
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() -
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Mobile:
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() -
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*Email:
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Previous Address
(If less than 5 years at current):
(City, State, ZIP)
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Previously Own or Rent?
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Own
Rent
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Years at Address
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How Did You Hear About Christman Fuel?:
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Employment Information: |
Employer:
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Address:
(City, State, ZIP)
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Phone:
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() -
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Position:
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How Long Employed:
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Landlord Information: |
Landlord:
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Landlord's Address:
(City, State, ZIP)
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Landlord's Phone:
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() -
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Co-Applicant Information: |
Co-Applicant Name:
(First, MI, Last)
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Mr. Ms. Mrs.
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Date of Birth:
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Billing Address:
(City, State, ZIP)
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Years at Address
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Previous Address
(If less than 5 years at current):
(City, State, ZIP)
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Years at Address
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Phone:
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() -
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Work:
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() -
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Mobile:
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() -
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Email:
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Co-Applicant's Employer:
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Address:
(City, State, ZIP)
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Position:
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How Long Employed:
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Application Agreement:
PLEASE READ AND UNDERSTAND THE FOLLOWING BEFORE SIGNING THIS APPLICATION.
Applicant/Co-Applicant does specifically authorize Christman Fuel Services ("CFS") to request a consumer credit report in connection with this application or in connection with updates, renewals, extensions, or enforcements of any credit granted as a result of this application. The Applicant/Co-Applicant may inquire of CFS whether or not a consumer credit report(s) was/were obtained and shall be told to name and address of the consume's reporting agency that gave the report(s). Applicant/Co-Applicant authorizes CFS to start a credit investigation based upon the above information which was voluntarily provided. The information provided is true and accurate. BANKRUPTCY: A bankruptcy proceeding is not recently in progress or expected. FAIR CREDIT REPORTING ACT DISCLOSURE: This application for sales on credit may be considered by CFS, now and from time to time, as to whether its continues to meet the credit requirements of CFS. NEW YORK RESIDENTS: New York law prohibits discrimination on the basis of martial status or sexual orientation. IF YOU ARE MAKING THIS APPLICAITON INDIVIDUALLY AND NOT JOINTLY WITH YOUR SPOUSE, PLEASE PROVIDE THE FULL NAME AND CURRENT ADDRESS OF YOU SPOUSE. TERMS: A FINANCE CHARGE OF 1 1/2% PER MONTH WHICH IS AN ANNUAL PERCENTATGE RATE OF 18% WILL BE APPLIED TO AMOUNTS OVER 30 DAYS. WE FIGURE THE FINANCE CHARGE ON YOUR ACCOUT BY APPLYING THE PERIODIC RATE TO THE "ADJUSTED" BALANCE" OF YOU ACCOUNT. WE GET THE "ADJUSTED BALANCE" BY TAKING THE BALANCE YOU OWED AT THE END OF THE PREVIOS BILLING CYCLE INCLUDING ANY UNPAID FINANCE CHARGES AND SUBTRACTING ANY PAYMENT AND CREDITS RECIEVED DURING THE PRESENT BILLING CYCLE. Finance charges will be applied on a monthly basis. If a lawyer or legal proceedings are necessary to enforce collection, the Applicant/Co-Applicant agrees to pay all reasonable attorneys fees and costs. PERIOD OF AGREEMENT: This application and its terms will be an agreement in effect as of the date of acceptance by CFS and it shall continue in effect until terminated in writing by Applicant/Co-Applicant or CFS. DELIVERIES: Unless otherwise requested, deliveries will be made in accordance with CFS's automatic degree-day service. Use of this service does not nullify the Applicant/Co-Applicant's responsibility to see that an adequate fuel inventory is on hand. NOTICE: Do not sign this Agreement if you believe important information has been omitted. You are entitled to a copy of this Agreement. FACSIMILE: An electronic transmission or copy of one shall be effective, enforceable and valid as if it contained an original written signature.
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*Applicant Signature:
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*Date:
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Please check the checkbox to verify: |
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