We will start processing your account, and we will follow up with you later for the additional information. If you prefer, you can call our office and complete the process by phone. Note: This is a secure web page. Any data you provide will be secure and subject to our privacy policy.   PART I: APPLICANT INFORMATION   APPLICANT INFORMATION Name * Mailing Address * City / State / Zip Code * Home Phone * Cell Phone Work Phone E-mail * Emergency Contact Name, Address & Tel. # of Nearest Relative Not Living With You Employer Social Security Number (SSN only required if authorizing credit check) SPOUSE/CO-APPLICANT INFORMATION Name Social Security Number (SSN only required if authorizing credit check) Employer Home Phone Cell Phone Work Phone E-mail CORPORATE ACCOUNT INFORMATION Company / Contractor Name Name of Authorized Agent I hereby personally guarantee payment on behalf of the company. Yes   PART II: DELIVERY INFORMATION   DELIVERY LOCATION INFORMATION Delivery Address * City / State / Zip Code * Delivery Location Phone Color / Description of House Fuel Type * Fuel Oil Kerosene Propane Other Please explain if you chose "other" Tank Location * Inside Tank (Fuel Oil Only) Outside (In-ground) Outside (Above-ground) Tank Size (275 gals is average for fuel oil) * Current Tank Level Number of Tanks * Fill Pipe Location (if standing on street and facing house) * Front Left Front Right Front Center Rear Left Rear Right Rear Center Right Side Left Side I'm not sure ADDITIONAL DELIVERY LOCATION INFORMATION Rent or Own? Rent Own Landlord Name (if renting) Landlord Address (if renting) Landlord Phone Number (if renting) If secondary home, time of year property is used Alternate/Backup Heat Source? No Electric Propane Wood Type of Heating System Boiler (forced water or steam) Furnace (forced air) Monitor Fuel used to heat your Hot Water Oil Monitor Electric Gas Other AUTHORIZATIONS Authorization #1 * I/We authorize Stafford Oil to deliver when I/we are not home. I/We do not authorize Stafford Oil to deliver when I/we are not home. NOTE: If "not home" is left unchecked, you will be required to be present at the delivery location any time a delivery is made and you will be unable to utilize our Automatic Delivery service. Authorization #2 * I/We authorize Stafford Oil to investigate my/our credit I/We do not authorize Stafford Oil to investigate my/our credit NOTE: If "do not authorize" is checked, payment terms will be C.O.D. Type of Delivery Requested if Credit is Granted * Automatic Call-In NOTE: Please read our Credit, Delivery, and Service terms before submitting the form. I/we agree that I/we have read and accept Stafford Oil's Credit, Delivery, and Service Terms. * Yes How did you hear about us? Security Code *