RESIDENTIAL FUEL DELIVERY CREDIT APPLICATION
Fields marked with an asterisk (*) are required.

 

 

*Date: 

 

*Name:      *SS #: 

  

*Street:   

 

*City:      *State:      *Zip: 

 

*How long at this address? 

 

*E-mail Address: 

 

*Home phone:       *Work Phone: 

 

  Mobile #:         Beeper: 

 

*Employer:       *How long at this job?: 

 

 

BILLING ADDRESS (IF DIFFERENT):

 

Street: 

 

City:      State:      Zip: 

 

Phone: 

 

 

IF JOINT APPLICATION PLEASE COMPLETE:

 

Name:        SS #: 

 

E-mail Address: 

 

Street:   

 

City:      State:      Zip: 

 

Home Phone:       Work Phone: 

 

Employer: 

 

 

LANDLORD (IF TENANT):

 

Name: 

 

Street:      

 

City:      State:      Zip: 

 

Home Phone:       Work Phone: 

 

 

PREVIOUS ADDRESS:

 

*Street: 

 

*City:      *State:      *Zip: 

 

*Phone:       *How long at this address? 

 

 

NEAREST RELATIVE NOT LIVING WITH YOU:

 

*Name: 

 

*Street: 

 

*City:      *State:      *Zip: 

 

*Phone: 

 

 

 

TYPE OF DELIVERY:     AUTOMATIC DELIVERY         JULIAN

 

TANK LOCATION:     ABOVE GROUND         BELOW GROUND

 

TYPE OF OIL:     FUEL OIL         KEROSENE

 

SPECIAL INSTRUCTIONS: 

How did you hear about us? 

 

Terms of Application
Applicant(s) consents to a credit check based upon the information provided on this application for the purpose of extending credit.  Applicant(s) further understand that the terms of this agreement will begin on the date of acceptance by Bain Oil Co., Inc. and will continue until either party terminates the agreement in writing.  Our automatic delivery customers agree that use of this service does not nullify their responsibility to see that they have an adequate supply of fuel on hand.  We expect payment each month and will apply a finance charge of 1% per month (18% annually) on a monthly basis to any balance remaining unpaid over 30 days.  Our customers agree to pay all reasonable collection and attorney’s fees if legal proceedings become necessary to enforce collection.

 

APPLICANT #1:

 *I agree to the above terms.      *Name:       *Date:

 

APPLICANT #2:
(*Required if Joint Application)

  I agree to the above terms.     Name:       Date:

  

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*

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PRODUCTS & SERVICES

  • Home Heating Oil and Kerosene
  • Gasoline and Diesel Delivery
  • Above Ground Fuel Oil Tank Installation
  • Commercial and Residential Deliveries
  • Natural Gas Systems, Oil Burners, Heat Pumps
  • Fuel for Emergency Generators at hospitals, nursing homes, manufacturing plants, computer labs, etc.

We also install and service heating and air conditioning systems through our Bain Heating and Bain Air Conditioning divisions.

SERVICE AREAS

  • Randolph County, Guilford County, Forsyth County, Davidson County, and areas of Rockingham County and Alamance County
  • Greensboro, High Point, Winston-Salem, Kernersville, Summerfield, Oak Ridge, Stokesdale, Colfax, Pleasant Garden, Reidsville, Browns Summit, Gibsonville, McLeansville, Whitsett, Julian, Jamestown and surrounding areas
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