TO SIGN UP FOR Automatic Delivery you must fill out our CREDIT Application:
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Name (First, MI, Last)(*)
Please provide us with your name
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Co-Applicant's Name: (First, MI, Last)
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MAILING ADDRESS INFORMATION:
Your Address: (City, State, ZIP)(*)
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Phone (Night)(*)
Please provide us with your phone number
Phone (Day)(*)
Please provide us with your phone number
Phone (Delivery)(*)
Please provide us with your phone number
Email(*)
Please provide us with your email address
Do you own your own home?
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For how many years
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Name of person or organization that referred you to us:
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LANDLORD INFORMATION:
If you rent, please complete landlord's information
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Name (First, MI, Last)(*)
Please provide us with your name
Landlord's Address: (City, State, ZIP)(*)
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Your Previous Address: (City, State, ZIP)(*)
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DELIVERY INFORMATION
I need
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Former Fule Supplier(*)
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Delivery Address: (City, State, ZIP)(*)
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Nearest Cross Street
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Fill Pipe Location
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Tank Size (in gallons)(*)
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Oil Type(*)
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Annual Usage(*)
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Burner Brand
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Do you use oil to heat your hot water?
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Delivering
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CREDIT INFORMATION
Social Security No: (Applicant)(*)
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Social Security No: (Co-Applicant)
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Employers Name(*)
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Bank Name(*)
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Bank Address (City, State, ZIP)(*)
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Checking Account Number(*)
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Savings Account Number
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I authorize Reichert Oil to check my credit rating. Your Name:(*)
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NOTICE: If we refer your account to collection, your account will increase by 25%. In the event your account is referred to an attorney, you will pay lawyer's fees of 25% of the total unpaid balance in addition to any costs incurred.
