Fillable New Account Form (Page 2 of 2) in pdf

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Fuel & Service Information Form

Seacoast Energy Solutions

PO Box 448, Newcastle ME 04553

PH: 207-563-7118 Fx: 207-563-7295

Applicant Name:

Applicant name:

Delivery/Service address (#1):

City, State, Zip:

Delivery/Service Instructions/Directions:

What kind of fuel do you use?

#2 Fuel _____ K1 _____ Propane ______ For propane, is there a tank(s) there now? _________ If so, who

owns the tank(s)? ___________________ What size tank(s)? _______ _______ _______

Annual Gallons _______________

What type of account do you prefer? WC (will call) ____ or KF (keep fill) _____ If keep fill, how many gallons were delivered last heating

season? ______________

(All KF accounts must either be credit approved or have a form of payment on file)

Location of your fill pipe or outside tank:

Tank level now? __________

# of Oil tanks ________ Oil tank size ________ Indoor □ Outdoor □

Fuel is used for

heat_____ hot water_____ generator_____ cooking_____ decorative stove_____ dryer_____ wall heater__

(check all that apply):

What type of heating system do you have? Furnace (warm air)_____ Boiler (baseboard)_____ Wall units_____ Wood/Pellet Stove_____

Make:________________ Model:________________ Age:_____ Domestic Hot Water Make:__________ Domestic Hot Water Model: _________

Delivery/Service address (#2):

City, State, Zip:

Delivery/Service Instructions/Directions:

What kind of fuel do you use?

#2 Fuel _____ K1 _____ Propane ______ For propane, is there a tank(s) there now? _________ If so, who

owns the tank(s)? ____________________ What size tank(s)? _______ _______ _______

What type of account do you prefer? WC (will call) ____ or KF (keep fill) _____ If keep fill, how many gallons were delivered last heating

season? ______________

(All KF accounts must either be credit approved or have a form of payment on file)

Location of your fill pipe or outside tank:

Tank level now? __________

# of Oil tanks ________ Oil tank size ________ Indoor □ Outdoor □

Fuel is used for

heat_____ hot water_____ generator_____ cooking_____ decorative stove_____ dryer_____ wall heater__

(check all that apply):

What type of heating system do you have? Furnace (warm air)_____ Boiler (baseboard)_____ Wall units_____ Wood/Pellet Stove_____

Make:________________ Model:________________ Age:_____ Domestic Hot Water Make:__________ Domestic Hot Water Model: _________

Terms and Conditions: 1) All customers must comply with normal, safe delivery conditions, including minimum delivery quantities (>100 gallons), accessible

driveway and fill access, and functioning vent alarm systems. 2) The customer certifies that the oil storage tank and associated piping located at the delivery

address above meets all applicable building codes, does not leak, does not have excess corrosion, and is properly connected to a working heating

system.

3) The

customer acknowledges that their driveway can sustain the weight of a fully loaded fuel truck (up to 45,000 lbs.) without damage. 4) Repeat delivery attempts, or

deliveries less than the minimum 100 gallons (or 50% of propane tank) will be assessed delivery charge set forth at our current rate. 5) Service Plan activation is

contingent upon technical inspection, and excludes any pre-existing conditions. 6) SES will not be liable for failure to provide product or services in the event of fuel

shortages, civil disorders, natural disasters, and other acts for force majeure beyond our reasonable control including your driveway condition. Should a failure occur

in any part of the supply chain due to natural or man-made events beyond SES control, this agreement may be voided. 7) Delivery status changes must be done in

writing. We will not accept cancellations from a third party. 8) Service plans and automatic delivery will be renewed automatically each year without further

notification from SES. 9) Scheduling for an automatic delivery agreement is based on usage history. All customers, new and existing, must provide Seacoast

Energy Solutions with an accurate projection of annual gallons used. Your responsibility prior to the commencement of the agreement is to ensure that your usage

information is current. All Budget plans require the tank be full and paid in full prior to the start of the payment plan. Please contact our office if you add appliances

or family members which will affect your monthly usage prior to and during the heating season. There will be a charge set forth at our current rate if an emergency

occurs and you run out of fuel due to increased usage over 20% of your historical usage amount. Price Protection plans do not automatically renew. Payment terms;

all other charges or outstanding balances must be paid in full before customer can participate in any program. Non-payment of any program fee voids this

agreement.

Applicant Signature: ____________________________________________

Date:___________________________

2nd Applicant Signature: _________________________________________

Date:___________________________