Residential Credit Application

The following form is submitted over a secure connection and is encrypted for your security. If you would prefer to fill out a paper application, you can download and print the form here then mail it to the appropriate address.

Please enter the following information to start the application process. Be sure to provide complete and accurate information.

Applicant Information

Full Name:

Social Security #:

Birthdate:

Drivers License #:

Home Phone:

Mobile Phone:

Email Address:

Would your like to have invoices / statements emailed to you?

Current Mailing Address:

City:

State:

Zip:

How Long?

Previous Mailing Address:

City:

State:

Zip:

How Long?

Current Employer:

Address:

Phone:

How Long?

Nearest Relative:

Relationship:

Address:

Phone:

* Relative must not reside in the same household.

Co-Applicant Information

Full Name:

Social Security #:

Birthdate:

Home Phone:

Mobile Phone:

Email Address:

Current Employer:

Address:

Phone:

How Long?

Previous Fuel Supplier

Company Name:

Address:

Account #

Acct. Type:

Products & Service Information

Delivery Address and Directions:

Please select the products you would like delivery service for, and an accurate estimate of your annual usage for each:

Fuel Oil

Kerosene

Propane

Gasoline

Diesel Fuel

Delivery Schedule:

TankSure^® Program:

Service Contract:

Type of Account Requested:

About Your System

Hot Water Type:

Heating System:

If Other, Please Describe:

# of Fuel Tanks:

Total Capacity:

Current Fuel Level In Tank:

Tank Location:

Propane Tank Size:

Furnace Mfg:

Burner Mfg:

Propane Use (check all that apply):

Cook Stove

Dryer

Primary Heat

Secondary Heat

Submit Application

In order to accurately plan for automatic deliveries, we rely on precise information from our customers as to the exact size of the fuel tank and any change in the use or discontinuance of supplemental fuels. In the event an automatic delivery customer runs out due to inaccurate tank size information and/or discontinuance of supplemental heat without notification to A.E. Robinson Oil Co., any related charges will be the responsibility of the customer.

Agreement - Please Read Before Signing

NOTICE: Consumer Reports (Credit Reports) may be obtained in connection with this application. If you request, you will be informed whether or not consumer reports were obtained and if reports were obtained, you will be informed of the names and addresses of the consumer reporting agencies (credit bureau) that furnished reports. The Federal ECOA prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status or age.

I understand and agree that by submitting these forms electronically, I authorize these forms to be as valid as manually signed forms submitted on paper. I further authorize my typed name and initials to be as valid as a manual signature and initials.

I (we) hereby agree to comply with the terms and conditions of the account established below.

Applicant Signature (Initials):

Co-Applicant Signature (Initials):

If you're not a robot, what is 600 + 37?

A.E. Robinson Oil Company Inc. Credit Policy

The following CREDIT POLICY is written and adopted to meet Federal and State Credit Laws. A.E. Robinson Oil Company will not discriminate in granting credit on the basis of race, color, religion, or marital status.

ALL BILLS ARE DUE UPON PRESENTATION. All account balances, which are unpaid after thirty (30) days from the billing date, are overdue. Terms are net 30 days.

CREDIT to approved accounts only. Credit approval is determined via a signed, completed credit application. Upon review of the application, an approval or denial letter shall be sent within 48 hours.

LATE CHARGES will be imposed on all overdue account balances at the rate of 1.5% per month (18% per annum).

AUTOMATIC DELIVERY is determined by A.E. Robinson Oil Company based on credit approval and/or credit history. ALL propane accounts must be on automatic delivery.

WILL CALL DELIVERY A customer may call when he/she wished product to be delivered. A.E. Robinson Oil Company shall deliver WCA on the next scheduled delivery day without a delivery charge.

DELIVERY CHARGES of $90.00 may be applied for an established customer for any delivery requested other than the regular delivery schedule. The delivery charge must be paid upon delivery.

C.O.D. ACCOUNTS require payment before or at the time of delivery. A C.O.D. account must submit a new credit application to be returned to Open Charge status.

BUDGET ACCOUNTS A customer with a zero balance and approved credit may request a budget account. Monthly payment amounts are determined by estimated usage for a twelve-(12) month period and may include a service contract. Accounts failing to remit two (2) consecutive payments will be removed from the Budget Plan, returned to standard pricing, taken off automatic delivery and placed on C.O.D.

COLLECTION COST may be added to any account that has an overdue balance. Cost may include, but not limited to, fees paid to the Court, Law Enforcement Agencies, Collection Agencies and Attorney fees. Copies of all collection costs shall be provided at the customer's request.

PUMP OUT charge will be charged for removing fuel from a tank.

CHANGE OF OWNERSHIP Customer must notify A.E. Robinson Oil Co. of any changes in ownership.