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Birthday
Month
Day
Year
Who is your Salesman?
None
Jesse
Michael
Other
Have you filed bankruptcy in the last 10 years?
Yes
No
What types of fuel do you use?
Which product would you like automatic fill?
How do you heat your hot water
Fuel Oil
Kerosene
Propane
Electric/Other

Propane Customers Only:

What do you use propane for?
If a new install, do you need lines run?
Yes
No
Who is your current supplier?
What size is your current tank?

If you subscribed to text notices above: by signing below you are agreeing to receive text notices regarding your deliveries, once available.  No mobile information will be shared with third parties/affiliates for marketing/promotional purposes at any time.


If you subscribed to eStatements above: by signing below you are agreeing to receive your monthly Statement via email to the email address provided on this document. Statements are processed on the 1st of each month if there is a balance on the account.


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.

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