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Automatic Delivery Agreement
Step
1
of
4
25%
Date
DD slash MM slash YYYY
First Name
Last Name
Spouse
Delivery Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Iowa
Kansas
Kentucky
Louisiana
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Maryland
Massachusetts
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North Carolina
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Ohio
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Delivery address the same as the billing address?
Yes
No
Billing Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Cell Phone
E-mail Address
PAYMENT METHOD
(Visa, MasterCard & Discover are accepted Credit Cards)
Debit Card
Credit Card
C.O.D.
Check (If applying for credit)
Card Number
Exp. Date:
MM slash DD slash YYYY
Social Security (Required for credit)
Social Security No. (Spouse)
TANK INFORMATION
What size tank do you have?
275 Gallons
330 Gallons
550 Gallons
1000 Gallons
Other
Other
Is your tank above ground/in basement or under ground?
Above Ground
Under Ground
Where is your oil fill pipe located?
Front Left
Front Right
Right Front
Right Back
Back Right
Back Left
Left Back
Left Front
How do you use your oil?
Heat Only
Heat & Hot Water
How much oil is in your tank now?
Full
3/4
1/2
1/4
E
Not Sure
BUDGET PLAN
Please check, if Customer desires to pay on installment basis. Customer agrees to company’s budget program and will make timely payments to enjoy company’s discount rates. (Other side of agreement details this program)
You must speak to office for budget amount.
DELIVERY & PAYMENT AUTHORIZATION
The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applications on the basis of sex or marital status. The Federal agency that administers compliance with this agreement concerning this creditor is The Equal Credit Opportunity, Federal Trade Commissions, Washington, D.C. 20580.
You are entitled to a copy of this agreement and the information regarding your rights to dispute billing errors.
Do not sign before completing the application and reading the entire Authorization Agreement.
Date
MM slash DD slash YYYY
Applicant Signature
RETAIL CREDIT AGREEMENT
AUTOMATIC DELIVERY – We will deliver, subject to availability, fuel oil at our established price at the time of delivery. Deliveries will be made on an automatic delivery basis according to a Weather Controlled Degree Day System. Unless requested in writing, deliveries will be made year round for customer with oil fired hot water systems when the company determines such deliveries are required. If customer’s account is past due, then the company cannot be responsible for out of oil calls. *I hereby authorize Fox Fuel to check my credit and employment history.
BUDGET PLAN – Budget payments are based on a 10 month period (August thru May) and are due the fifteenth day of each month. Budget payments apply to oil deliveries only and all service calls will be billed separately. All invoices pertaining to deliveries should be retained for your records. All prompt payment discounts will be applied at the end of the budget year if all payments are received when due. If payments are past due, then the company shall not be responsible to make delivery until account is current. The company reserves the right to increase customer’s budget amount if actual usage is greater than anticipated. Formula used for same will be stated with budget envelopes.
MONTHLY STATEMENTS – If a balance exists in your account, a statement will be sent, reflecting any purchases, past due amount, and LATE CHARGE of 1½% per month (ANNUAL PERCENTAGE RATE OF 18% PER ANNUM).
PAYMENTS – A metered ticket will be left after each delivery. This ticket will serve as an invoice and payment can be made from this ticket in order to benefit from any prompt payment discounts that should apply. Another invoice will follow the delivery as a reminder of amount due. Any checks returned due to non-sufficient funds will be charged a return check charge of $25.00 (residential customers) and $40.00 (commercial customers) and prompt payment discount will be disallowed.
TENANT-LANDLORD POLICY – In the case of rental properties, it is the company’s policy that both the tenant and landlord assume responsibility for the account. If either party cannot assume responsibility, a letter must accompany customer’s credit application stating same. The company reserves the right to contact either party to satisfy overdue balances. A copy of this agreement must be signed by all parties concerned.
CANCELLATION – Either party can cancel this agreement with 30 days written notice. Customer agrees that they will be responsible for payment for any deliveries made due to failure to make such notice. The company may cancel this agreement without notice for failure to pay overdue balances.
DEFAULT AND COLLECTION COSTS – Customer will be in default for failure to make timely payments, file for bankruptcy, or make an assignment for the benefit of creditors. Default means that demand can be made for payment in full. If collection is referred to an attorney, then customer will pay all court costs.
AMENDMENT OR CHANGES – The company can change this agreement including LATE CHARGE and the ANNUAL PERCENTAGE RATE, at any time, provided we give the customer at least 30 days written notice before the billing period in which the change becomes effective.
LIABILITY – The company is not responsible for damage or loss caused by failure to make delivery due to labor shortage, strikes, or to conditions beyond it’s control. In the event of DEFAULT and oil is not delivered as a result of DEFAULT, the company will not be liable for any damages in either a direct or indirect manner.
Fox Fuel
(215) 659-1616
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