Customer / Credit Application 

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Applicant Information

Customer Name:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
SSN:
Work Location:
Email Address:

Equipment Details

Is your oil tank underground ?	YesNo
What size is your oil tank ?	Please Select 275 Gallon 330 Gallon 550 Gallon 1000 Gallon Other
Current oil level in your tank ?	Please Select Full 3/4 Full 1/2 Full 1/4 Full Less than 1/4 Full
Tell us about your heating system:	Please Select Warm Air Furnace Hot Water Boiler Steam Boiler
Last date of Annual Maintenance:	January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Former Oil Company Name:
Send a cancellation letter?	YesNo
How do you heat your Hot Water?	Please Select Oil Electric Gas Propane
Location of fill pipe (facing house from street):	Please Select Front Right Front Left Rear Right Rear Left Right Side Left Side
Comments:
	OIL TANK - I have inspected my oil tank (tanks) and have found no signs of leaks,srews or any type of patches. I also have the proper permit from local fire dept. for oil storage on my property.
	OIL LINE - I have inspected my oil line running from the oil tank to the oil burner and found it to be encassed in a plastic sleeve (protected) or a oil safety valve installed. I am aware that either must be in place to be in complance with State codes and insurance requirements.
	DELIVERY and SERVICE - I authorize EES to drive delivery or service vehicles on my property for filling my oil tank or perform service on my heating equipement.