FSi Oil Services - New Customer Signup

First Name *

Last Name *

Social Security *

Billing Street Address *

City *

State *

Zip Code *

Delivery Street Address *

City *

State *

Zip Code *

Home Phone

Email *

Cell Phone

Do you own or rent? *OwnRent

Previous Oil Supplier *

Landlord Name

Landlord Address

Landlord Phone

Landlord Email

Type of Delivery *Automatic DeliveryWill Call

Estimated Annual Usage *

Tank Location *BasementOutsideUnderground

What is your tank used for? *Heat & Hot WaterHeat Only - your water is heated by gas or elect.

Fuel Type *

Special Instructions for delivery

Tank Size *

Amount in Tank *

Are you interested in any of the programs? Budget Service Agreement Price Cap Pre Buy

We may order a consumer report in connection with this application and subsequent consumer reports in connection with updating, renewing and reviewing the existing or future extensions of credit. Upon your request, we will provide the name and address of the consumer credit reporting agency furnishing such report to us. The Federal Equal Opportunity Act prohibits us from discriminating against you in any way in the granting of credit. The Federal agency which administers compliance with this law is the Federal Trade Commission, Washington, DC 2058 We have given to you and you acknowledge receipt of a complete description of the terms of our Retail Credit Agreement and your Billing Error Rights, which appear in subsequent form you will sign after submitting this application. * I have read these terms and agree