Credit Applications

Please copy and paste the following to a Word document, then print out the form, fill out, sign, and fax or mail it back to us at:

Mail address:             P.O. Box 21

                                      Milton, Vt

                                          05468

Fax:                           (802)-893-3201

Credit Application

(Required field *)

* Name________________________________________________________________

* Address______________________________________________________________

* Telephone:

Home_________________________Business _________________________

* Place of Employment________________________________________________

Social Security Number________________________________________________

References:

* Bank & Account Number _____________________________________________

* Phone_________________________________________________________________

Bank & Account Number ______________________________________________

Phone____________________________________________________________________


Credit:

* Name____________________________________________________________________

* Address_________________________________________________________________

* Phone__________________________ * Account No. _______________________________

Name_________________________________________________________________________

Address_______________________________________________________________________

Phone_____________________________ Account No._______________________________

Previous Fuel Supplier___________________________________________________________

 

* Type of Furnace:

Hot Water Hot Air

* You are interested in:

AUTOMATIC BUDGET

I wish to open a charge account with ROWLEY FUELS, INC. I understand that the terms are 'net' thirty days from date of purchase. I further understand that a finance charge of 1 1/2% per month will be added to all accounts past due (Annual Rate 18%). I also agree that any fees incurred in collecting my account may be added to the balance due.

The undersigned consumer does hereby authorize and give consent to ROWLEY FUELS, INC., its representing agents and/or attorneys to access their consumer credit file and to thereby obtain any reports necessary for the purpose of verifying credit history, securing financial arrangements, reviewing / monitoring account(s), collection action, or any other legitimate purpose associated with this or any other future service or transaction pursuant to 9 V.S.A.2480 (e) and 2480(g).

*Signature____________________________________________*Date____________________

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