Suburban Fuel Company, LLC
703-971-2444 phone s 703-971-4621 fax
SFC Heating & Air Conditioning, LLC
703-778-4665 phone s 703-778-4668 fax
5604 Oakwood Road s Alexandria, VA 22310
APPLICATION FOR CREDIT
PERSONAL INFORMATION
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Last Name First Name Middle Initial
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Home Address Own or Rent
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City State Zip
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Home Phone Number Social Security Number -- Required in order to process
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Billing Address (if different from above)
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City State Zip
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Employer Phone Number
FUEL INFORMATION (Please check all that apply)
Type of Fuel: ÿ 1-Kerosene ÿ 2-Fuel Oil ÿ HVAC Service Only (no fuel)
Tank Size: ÿ 1,000 gallons ÿ 550 gallons ÿ 500 gallons ÿ 275 gallons ÿ 250 gallons ÿ Other
Type of Delivery: ÿ Will Call ÿ *Automatic Does your oil heat your hot water? ÿ Yes ÿ No
Account Type: ÿ Pay on Delivery ÿ Bill Me: Net 30 Days ÿ ** Charge to my Credit Card
**Credit Card: ÿ MC ÿ VISA -Number: ______-______-______-______Exp. Date: ______
*An Automatic Customer is monitored by the office for fuel deliveries. The office determines each of your oil deliveries by Degree Days. You, the customer, will not have to call to schedule oil deliveries. Our driver will leave a copy of the ticket with your gallons on it at your house. Then we will take care of your account as indicated above. Please read terms for Automatic Customers on the backside of this form.
**Credit Card Terms – By marking “Charge to my credit card” and filling out your credit card information, you authorize Suburban Fuel Company to charge your personal credit card for each purchase made on this account. Suburban Fuel will notify you when your card is coming up for renewal.
Please see reverse side. The application must be signed or it will not be processed.
TERMS
Ø Net 30 days from the invoice date or your account will compute a late charge of 1.5% monthly to all accounts past due.
Ø IF YOU ARE AN AUTOMATIC CUSTOMER - It is YOUR RESPONSIBILITY to let us know if you move, rent your property or convert to gas or electric heat. YOU MUST CALL THE OFFICE AND STOP YOUR OIL DELIVIERIES. If you do not inform Suburban Fuel Company immediately, you will be responsible for any additional oil deliveries made to the property.
It is your responsibility to inform us if you go out of town for more than a week.
This is to let Suburban Fuel Company know not to hold any deliveries if we have not
received any payment for a bill due.
**WE ARE JUST LIKE ANY OF YOUR OTHER UTILITIES!**
Ø CREDIT CARDS - If you have filled out the credit card information on the front side, you authorize Suburban Fuel Company to charge you credit card for every purchase made on your account. You may change this status at any time as long as a credit check has been done unless you choose to pay COD.
Ø I further agree to pay for a collection cost of at least 33 1/3% and/or any reasonable attorney fees or court costs incurred by Suburban Fuel Company or SFC Heating & A/C, if made necessary by failure to comply with the payment terms of sale.
Ø Checks returned due to insufficient funds or checks written on a closed bank account will be assessed a flat fee of $25.00 each time they are returned, limited to a $50.00 total fee assessment for each check.
By signing this application for credit, you hereby state that all of the information is true and correct and give your consent to check any information necessary in processing this credit application. You promise to pay for all purchases in accordance with the terms of sale. You also agree to the above collection terms should your account become past due.
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Signature Date