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  Cash Price 
      #2 Heating Oil: $2.399

 

Credit Application

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HR Clough Account Number



Credit Card Information (Optional)

Credit Card Type: Visa
MasterCard
Discover
AMEX

Credit Card Number:

Name on Credit Card:

Billing Address:

City, State, Zip:

Phone:

E-mail Address:

Expiration Date:

3 Digit Security Code:



Applicant #1

* Name:

* Social Security Number:

* Delivery Address:

* City, State, Zip:

* Home Phone:

* Employer:

* Work Phone (Optional):

* Cell Phone (Optional):



Applicant #2 (If applying for joint account)

Name:

Social Security Number:

Delivery Address:

City, State, Zip:

Home Phone:

Employer:

Work Phone (Optional):

Cell Phone (Optional):



Billing address if different than above

Billing Address:

City, State, Zip:



Previous Address

Address:

City, State, Zip:



Previous Fuel Supplier:

How did you hear about us?:

Additional Comments:



** NOTE: Please have 2 consecutive delivery slips handy in order for us to establish a history for calculating automatic delivery sechedules.

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 H.R. Clough, Inc./Kearsarge Heating Oils. If credit is advanced, borrower, agrees to the following terms: Provided no special pricing agreement is made, terms are NET 30 from date of all invoices or if the entire account balance is paid in full within 10 days of a fuel delivery, a discount of $ .10 per gallon will be allowed. A finance charge of 2% per month (24% annually) will be assessed monthly on any balance remaining unpaid 30 (thirty) days after billing date. Our customers agree to pay all fees in connection with the collection process, whether imposed by H.R. Clough, Inc./Kearsarge Heating Oils, local law enforcement or through the small claims process.

By check the box below, I agree to all terms above and attest that all information provided is correct to the best of my ability:

Yes, I authorize:

Name:

Date: