Account Application Information New Account Application – UPDATED New Account Application Is This Application For Your Home or Business?* Home Business Full Name:* Email:* Home Phone:* Cell Phone: Fax: Delivery Address:* City:* State:*VermontNew HampshireMassachusettsZip:* Use Delivery Address as Billing Address Billing Address:* City:* State:*VermontNew HampshireMassachusettsZip:* Others authorized to request service or delivery:If none, you will be the only person able to request a delivery or service.Residence/Business InformationHow Long Have You Been At This Address:*Enter years and months, please. Do you rent or own this property?* Rent Own Do you intend to rent it?* Yes No Landlord's Name: Landlord's Address: Landlord's Phone: Employment InformationEmployment Status* I’m employed I’m retired Applicant's Employment:* Years With Company:* Employer's Phone:* Employer's Address:* Employer's City:* Employer's State:* Employer's Zipcode:* Products of Interest If you would like to include more detailed information please use the fields below. (This is NOT required but will help us provide a more comprehensive follow up with you.)FUELS Oil Gasoline On-Road Diesel Off-Road Diesel Kerosene Bulk Motor Oil Other SYSTEM Annual Tune-Up Heating System Service or Installation Oil Tank Service or Replacement How did you hear about us?* Newspaper Radio Email Online Search Social Media (Facebook/Instagram) Friend Other Certification*I hereby certify that I am the above applicant and the information is true, correct, and complete to the best of my knowledge. This information has not been and will not be used for any other purpose, or made available to any other person other then for the use of Barrows and Fisher Oil Company. You have my permission to request a credit report and verify any of the above information. If credit is hereby granted, I/we agree to pay the account in full within the thirty (30) day credit terms. A finance charge of 1-1/2% per month (annual percentage of 18%) will be assessed on all accounts unpaid in thirty (30) days following the due date. Non-compliance with credit terms may result in the disruption and/or termination of fuel oil deliveries. Yes, please authorize credit check. No, I do not authorize. Signature of Applicant:* CAPTCHA Δ