Applicant
Name:
E-mail		Soc. Sec. #
Phone		Cell Phone

Co-Applicant
Name:
E-mail		Soc. Sec. #
Phone		Cell Phone

Delivery Address
Street:
City:		State:		Zip:

Existing Home

Mobile Home

New Construction

Owner

Tenant

Mailing Address (if different)
Street:
City:		State:		Zip:

Former Address (if less than 2 years at present address)
Street:
City:		State:		Zip:

Name of Landlord or Mortgage Co.:
Name:			Phone:

Applicants Employer
Name
City:		State:		Zip:
Phone		How Long

Co-Applicants Employer
Name
City:		State:		Zip:
Phone		How Long

PLEASE READ CAFEFULLY

1.Weaver Petroleum Inc., of Lititz, Pennsylvania, and the undersigned Applicant(s) to deliver heating and fuel oil to the delivery address listed above on a regular basis. Company shall estimate the rate of consumption of fuel based on the size of the storage tank, size of the building, the temperature, and other factors and shall make deliveries from time to time without being called by Applicant(s); however, if Applicant(s) storage tank runs out of fuel for any reason, Company shall in no manner be liable for any damages, direct or indirect, resulting from the tank being empty. (This paragraph does not apply to service only or will call accounts.) 2.Applicant(s) shall pay all bills from Company promptly upon receipt. If payment is not made in full within 30 days from the date of the bill, as to that amount which is unpaid, Applicant(s) shall be deemed in default and Applicant(s) hereby authorizes Company to charge the maximum late/default charge permitted by law ( currently in Pennsylvania the maximum permitted late/default charge is 1.50% per month on unpaid balance.) In addition, if the customer's account is turned over to an attorney for collection, the customer shall be responsible for all attorney's fees and costs of collection incurred by Company. 3.Company is hereby authorized to investigate all references or other information listed herein, including engaging of any credit-reporting agency to make a determination of the qualifications of Applicant(s) for an account. I (we) authorize any or out creditors, banks and other references to release all requested account information to Company. By allowing the customer to open an account with Company, Company is not extending credit or allowing deferred payment.

I Agree I Do Not Agree

Heating Systems (check all that apply)

Oil Furnace	Oil Boiler	Oil Hot Water Heater
Gas Furnace	Gas Boiler	Gas Hot Water
Electric Hot Water	Heat Pump

Other Information:
Ticket should be left at which door:		Fill Location:
Fill Instructions:
Last time heating unit was cleaned:		Do you have central air?:
Last time A/C unit was cleaned:		Oil Tank Size/ Gal.:

Pay per Delivery	Pre Pay	Budget	Burner Service Contract	Installation