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How would you like to receive monthly statements?
Do you rent your home?
What types of fuel do you use?
Would you like access to your account online?
Have you or your spouse ever filed bankruptcy?
Which product would you like automatic fills:
How do you heat your hot water:


What do you use propane for?
If you are a new install, do you need lines run?

If you are switching to us:

Who is your current supplier:

What size is your current tank:  

Usual annual usage:  

The undersigned agrees to allow Philly Fuels Inc permission to pull a credit report to open a charge account.  In consideration of the granting and extension of credit by Seller to the undersigned, it is hereby agreed that the undersigned will promptly pay all sums when due.  In the event of non-payment, the undersigned does hereby agree to pay in addition to the principal amount due, all collection charges incurred by Seller, including charges made by a collection agent and, in the event of suit, reasonable attorney’s fees and court costs.  The undersigned further agrees to pay service charges at the rate of 24% per year commencing the first day following the due date.  All sums are due within 30 days from delivery, future deliveries will not continue with any sum owed.

Typing my name below shall be recognized as my formal signature.

  • APPROVAL:  Based on credit score and recent account information.

  • If your credit is not approved, you might be eligible for our Mandatory Payment Plan.

  • You will receive notification via mail or email.  Or you can call anytime.

  • If you would like information about automatic delivery, budget plans or price protection, please call our office at (315) 642-5562, Monday - Friday, 7 am - 4 pm.

Thanks for submitting!

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