First Name  Middle Initial Last Name

Social Security Number Number of Dependents

Date of Birth Telephone Number Marital Status

Name of Spouse Maiden Name

Social Security Number Date of Birth

Current Street Address

City State: Zip:

Previous Address (If less than one year)

City State: Zip:

Employer Position How long?

Employer Address

City State Zip:

Spouse's Employer Position How long?

Net Monthly income including spouse    Is home owned? 

If not, name of landlord

Bank Type of account:   Mortgage   Loan  Checking Savings

Other Credit

Accounts:

Personal References

Name Address Telephone Number

Name Address Telephone Number

Previous Heating Supplier

Have you applied here for credit before?

Delivery Address if different from above:

By electronically transmitting this application via my e-mail address of  (insert your e-mail address here) I AGREE THAT: (1) People's Fuel & Trucking Inc. has my express consent to conduct an investigation about my credit background and (2) the approval of this application is subject to results of such an investigation and (3) I shall accept the terms and conditions as follows:  No finance charge will be assessed if payment of my current balance is paid within thirty (30) days.  Any amount no paid within 30 days will be charged  1-1/2% per month FINANCE CHARGE.  The minimum FINANCE CHARGE shall be 50 cents.

Name of person submitting this application

THE FEDERAL EQUAL CREDIT OPPORTUNITY ACT PROHIBITS CREDITORS FROM DISCRIMINATING AGAINST CREDIT APPLICANTS ON THE BASIS OF SEX OR MARITAL STATUS.  THE FEDERAL AGENCY WHICH ADMINISTERS COMPLIANCE WITH THIS LAW IS THE FEDERAL TRADE COMMISSION, WASHINGTON, D.C. 20580. 

THE POLICY OF PEOPLE'S FUEL AND TRUCKING IS: (A) NO APPLICANT MAY BE DENIED CREDIT BECAUSE OF THE APPLICANT'S SEX OR MARITAL STATUS. (B) THE APPLICANT MAY REQUEST THE REASON FOR REJECTION OF HIS OR HER APPLICATION FOR CREDIT. (C) NO PERSON NEED REAPPLY FOR CREDIT SOLELY BECAUSE OF A CHANGE IN MARITAL STATUS UNLESS THE CHANGE IN MARITAL STATUS HAS CAUSED A DETERIORATION IN THE PERSON'S FINANCIAL POSITION. (D) A PERSON MAY HAVE CREDIT IN ANY NAME PERMITTED BY LAW THAT HE OR SHE REGULARLY USES AND IS GENERALLY KNOWN BY, SO LONG AS NO FRAUD IS INTENDED THEREBY.