CREDIT APPLICATION FOR CHARGE ACCOUNT

Applicant's Social Security Number:

Full Name:

Age:

Street Address:

Spouse’s Full Name:

City, State, Zip:

How Long?

Telephone:

Previous Address:

How Long?

Presently Employed By:

How Long?

Business Address:

Position:

Business Telephone:

Spouse Employed By:

How Long?

Business Address:

Position:

Own House?

Mortgage

Bank Account (checking preferred):

Previous Oil Supplier:

REFERENCES

Name:

Address:

Account Number:

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Date:

Applicant’s Signature:

For Office Use Only:

Type of A/C:

Fuel Oil:

Other: