APPLICANT INFORMATIONName * Required First Last SSN * RequiredDate of Birth * Required MM slash DD slash YYYY PhoneCurrent Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Own or Rent Own Rent Other How Long?Monthly Payment or Rent ($)Previous Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Own or Rent Own Rent Other How Long?Monthly Payment or Rent ($)EMPLOYMENT INFORMATIONCurrent EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail How Long?PositionHourly or Salary? Hourly Salary Annual Income ($)PERSONAL REFERENCEName of Relative NOT Residing With You First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneRelationshipCO-APPLIANT (only for a joint account)Name First Last SSNDate of Birth MM slash DD slash YYYY PhoneCurrent Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Own or Rent Own Rent Other How Long?Monthly Payment or Rent ($)Previous Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Own or Rent Own Rent Other How Long?Monthly Payment or Rent ($)CO-APPLICANT EMPLOYMENT INFORMATIONCurrent EmployerAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail How Long?Hourly or Salary? Hourly Salary Annual Income ($)DELIVERY INFORMATIONType of Tank Above Ground Tank Under Ground Tank Tank SizeType of Fuel #2 Heating Oil Dyed Kerosene Type of Service Automatic Will Call Budget Used For Heat Only Water Only Heat and Hotwater Tank Location and Delivery InstructionsTerms and ConditionsConsent Terms - The buyer agrees to pay all Deliveries within 30 days of delivery. All unpaid balances over 30 days will be subject to finance charges at a monthly rate of 1.5%.Consent Automatic Delivery - Bogue Oil Inc. agrees to make timely deliveries as long as the account is current. Automatic service insures emergency deliveries in cases of accidental run outs.Consent Budget Account - All payments are due by the 15th each month. If the account becomes delinquent, deliveries will cease, total account balance becomes due and subject to all finances charges if not paid within 30 days.Consent Finance Charges - All accounts over 30 days old are subject to an 18% annual finance charge at a rate of 1.5% per month.Consent Collections - It is agreed that, in case of default on an account, the buyer agrees to pay court cost and attorneys fees up to 33% of the amount owed.Consent Changes to Account - Any changes to the account must be done in writing.Consent I authorize Bogue Oil Inc. to verify the information provided on this form as to my credit and employment history.CommentsThis field is for validation purposes and should be left unchanged. Δ
