# 0 ~# ~# ~# U U d > > R E S I D E N T I A L A C C O U N T C L A R K O I L N a m e F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ M a i l i n g A d d r e s s F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ C i t y F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ H o m e P h o n e F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ E m a i l A d d r e s s F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ P o s t a l C o d e F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A p p l i c a t i o n f o r : F O R M C H E C K B O X 3 0 d a y t e r m O i l A c c o u n t F O R M C H E C K B O X B u d g e t A c c o u n t F O R M C H E C K B O X H e a t i n g S e r v i c e P l a n F O R M C H E C K B O X E q u i p m e n t F i n a n c i n g / P u r c h a s e C r e d i t I n f o r m a t i o n M a r i t a l S t a t u s F O R M C H E C K B O X S i n g l e F O R M C H E C K B O X M a r r i e d F O R M C H E C K B O X O t h e r N a m e o f S p o u s e F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ R e s i d e n c e F O R M C H E C K B O X O w n F O R M C H E C K B O X R e n t , i f r e n t i n g N a m e o f L a n d l o r d & P h o n e # F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ F o r m e r R e s i d e n c e ( I f l e s s t h a n 2 y e a r s ) F O R M T E X T _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ A p p l i c a n t s S . I . N . # F O R M T E X T _ _ _ _ _ _ _ _ _ _ a n d / o r D a t e o f B i r t h F O R M T E X T _ _ _ _ _ _ _ _ _ _ C o - A p p l i c a n t o r S p o u s e s S . I . N . # F O R M T E X T _ _ _ _ a n d / o r D a t e o f B i r t h F O R M T E X T _ _ _ _ _ _ _ _ _ _ A p p l i c a n t s E m p l o y e r F O R M T E X T _ _ _ _ _ _ _ _ _ _ H o w L o n g F O R M T E X T _ _ _ _ _ _ P o s i t i o n F O R M T E X T _ _ _ _ _ _ C o - A p p l i c a n t s E m p l o y e r F O R M T E X T _ _ _ _ _ _ _ _ _ _ H o w L o n g F O R M T E X T _ _ _ _ _ _ P o s i t i o n F O R M T E X T _ _ _ _ _ _ D e l i v e r y S e r v i c e I n f o r m a t i o n D e l i v e r y A d d r e s s ( C i v i c # , R o a d / S t r e e t ) F O R M T E X T _ _ _ _ _ _ _ _ _ _ R e m a r k s F O R M T E X T _ _ _ _ _ _ _ _ _ _ T a n k C a p a c i t y F O R M T E X T _ _ _ _ F O R M C H E C K B O X F u r n a c e O i l F O R M C H E C K B O X F u r n a c e O i l L i g h t F u r n a c e T y p e F O R M C H E C K B O X W a r m A i r F O R M C H E C K B O X H o t W a t e r K 1 F O R M T E X T K 2 F O R M T E X T T a n k L o c a t i o n F O R M C H E C K B O X I n s i d e F O R M C H E C K B O X O u t s i d e H W H e a t e r F O R M C H E C K B O X O i l F O R M C H E C K B O X E l e c t r i c F O R M C H E C K B O X P r o p a n e L a s t O i l D e l i v e r y F O R M T E X T D e l i v e r y S e r v i c e F O R M C H E C K B O X C a l l F O R M C H E C K B O X A u t o m a t i c E s t . A n n u a l V o l u m e $ F O R M T E X T a n d / o r F O R M T E X T L F O R M T E X T A g e o f F u r n a c e F O R M T E X T _ _ _ T y p e o f H o u s e F O R M T E X T _ _ _ A p p r o x i m a t e S q u a r e F o o t a g e F O R M T E X T T e r m s o f A g r e e m e n t 1 . T h e C o m p a n y i s h e r e b y a u t h o r i z e d t o d e l i v e r y h o m e h e a t i n g o i l t o t h e c u s t o m e r s p r e m i s e s d e t a i l e d o n t h i s a g r e e m e n t , a n d t h e c u s t o m e r a g r e e s t o p u r c h a s e a l l o f h i s o il requirements from the Company until this Agreement is terminated by either party by either giving the other party written notice 30 days in advance. 2. The customer is responsible for having the premises checked at least every 24 hours and to provide easy and safe access to the fill site and to report any malfunction of the heating equipment, as the Company will not be liable for damage or freeze-up resulting from the customers failure to report same. Customers accepted on a call delivery basis must provide the Company with a minimum 48 hours notice of the request for delivery. The Company will not be responsible for oil run out resulting from the customers failure to provide such minimum notice. 3. The customer agrees to notify the Company of any changes that may affect the fuel consumption in the premises. 4. Under no circumstances does the Company as a condition of acceptance of this Agreement undertake to accept responsibility for the functioning of maintenance of the heating system and related equipment and damages resulting from same will not be the responsibility of the Company. Any damage of property or goods stored in the vicinity of the oil tank, boiler or furnace, will not be the responsibility of the Company. 5. Unless otherwise arranged and agreed to, accounts are due and payable on receipt of delivery. Overdue accounts are subject to a service charge up to 2% per month (26.824% per annum). Any lesser amount actually charged shall be without prejudice to the Companys right to claim at the full rate at any future time without notice. If an account becomes overdue, deliveries may be suspended or this Agreement may be cancelled without notice and the customer shall have no claim against the Company for any reasons. 6. The Company shall not be liable for failure to supply fuel oil hereunder if prevented by an act of God, strike, flood, fire, embargo, insurrection, unavoidable accident, shortage of labour or material, government decree or any other cause beyond its control or generally whenever th P R f h j t v " , . 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T h e c u s t o m e r a g r e e s t o n o t i f y i n w r i t i n g , t h e C o m p a n y o f a n y c h a n g e s i n o w n e r s h i p o f t e n a n c y o f t h e p r o p e r t y c o v e r e d b y t h i s A g r e e m e n t a n d f a i l i n g s u c h n o t i f i c a t i o n s h a l l b e r e s p o n s i b l e f o r a l l f u e l o i l d e l i v e r i e s m a d e t o t h e s a i d p r e m i s e s . 8 . T h e p r i c e a g r e e d u p o n i s b a s e d o n t h e C o m p a n y s c u r r e n t p o s t e d t a n k w a g o n d e l i v e r e d p r i c e a n d i s s u b j e c t t o a n y i n c r e a s e o r d e c r e a s e o f t h i s p o s t e d p r i c e i n e f f e c t a t t i m e o f d e l i v e r y . 9 . T h e C o m p a n y c a n n o t b e h e l d r e s p o n s i b l e f o r a n y d a m a g e c a u s e d a s a r e s u l t o f d i s c o n n e c t i o n o f t h e f u e l s y s t e m o r s t o r a g e b y t h e c u s t o m e r f o r w h a t e v e r r e a s o n u n l e s s t h e c u s t o m e r h a s g i v e n t h e C o m p a n y 1 5 d a y s w r i t t e n n o t i c e o f s u c h d i s c o n n e c t i o n . 1 0 . O u t s i d e s t o r a g e f a c i l i t i e s c a n b e s u b j e c t t o w a x i n g o f t h e p r o d u c t i n c o l d t e m p e r a t u r e s . T h e C o m p a n y w i l l n o t b e r e s p o n s i b l e f o r d a m a g e s w h i c h m a y r e s u l t f r o m f u e l o i l s t o r e d o u t d o o r s . 1 1 . T h i s A g r e e m e n t s h a l l n o t b e b i n d i n g u p o n t h e C o m p a n y u n t i l i t h a s b e e n a c c e p t e d a n d a p p r o v e d b y t h e C o m p a n y s C r e d i t D e p a r t m e n t . 1 2 . T h e p a r t i e s h a v e a g r e e d t h a t t h i s a g r e e m e n t a n d a l l d o c u m e n t s a n d c o r r e s p o n d e n c e t h e r e u n d e r b e d r a f t e d i n t h e E n g l i s h l a n g u a g e u n l e s s o t h e r w i s e r e q u e s t e d . 1 3 . T h e u n d e r s i g n e d a g r e e s t o p e r s o n a l l y g u a r a n t e e p a y m e n t t o t h e C o m p a n y f o r p r o d u c t a n d / p r s e r v i c e s b i l l e d t o t h i s a c c o u n t . 1 4 . T h e c u s t o m e r w i l l b e r e s p o n s i b l e t o p a y a n y a d d i t i o n a l c h a r g e s i n c u r r e d s h o u l d t h e a c c o u n t b e p a s s e d t o a t h i r d p a r t y c o l l e c t i o n a g e n c y f o r c o l l e c t i o n . 1 5 . T h e a c c o u n t s s t a n d i n g m a y b e r e p o r t e d t o t h e c r e d i t b u r e a u . I h e r e b y c e r t i f y t h e a b o v e i n f o r m a t i o n t o b e t r u e a n d c o m p l e t e . I a u t h o r i z e a n d c o n s e n t t o C l a r k O i l t h e a b i l i t y t o o b t a i n a n d e x c h a n g e c r e d i t i n f o r m a t i o n w i t h a n y p e r s o n o r c o r p o r a t i o n w i t h w h o m I h a v e o r p r o p o s e t o h a v e f i n a n c i a l r e l a t i o n s . F O R M C H E C K B O X A c c e p t D a t e F O R M T E X T _ _ _ _ S i g n a t u r e o f C u s t o m e r F O R M T E X T _ _ _ _ _ _ _ A u t h o r i z e d R e p r e s e n t a t i v e F O R M T E X T _ _ _ _ ( y o u r n a m e h e r e c o n s t i t u t e s s i g n a t u r e ) O f f i c e U s e O n l y : A c c o u n t N o . F O R M T E X T _ _ D a t e E n t e r e d F O R M T E X T _ _ _ T e r m s F O R M T E X T I n s p e c t i o n D a t e F O R M T E X T _ _ _ R o u t e # F O R M T E X T |X ~X dZ Z $$If a$t kd $$If T l 0 + 0 6 4 l a T ~X 4Y HY dZ fZ Z Z Z Z Z Z Z Z Z Z Z Z [ [ $[ &[ ([ 2[ 4[ B[ [ [ [ [ [ [ [ [ \ \ \ &\ F\ ʽϮʡϮʔϮʎو{o h:ZW CJ OJ QJ ^J h:ZW >*CJ OJ QJ ^J h:ZW CJ h:ZW CJ j` h:ZW >*U j h:ZW >*U j h:ZW >*UmH nH ujt h:ZW >*U h:ZW >*j h:ZW >*U h:ZW jq h:ZW CJ Uj h:ZW CJ U h@ CJ h:ZW CJ %Z Z [ \ \ . d kd $$If T l 4 \ + 9. 0 6 4 l a f4T $$If a$d kd $$If T l 4 h + 9. 0 6 4 l a f4T \ \ ] ] ] _ kd! $$If T l + . 0 6 4 l a T $dh $If a$ dh F\ H\ \\ ^\ `\ j\ l\ p\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ &] (] <] >] @] J] L] R] l] n] ] j (j h:ZW >*CJ OJ QJ U^J (j] h:ZW >*CJ OJ QJ U^J (j h:ZW >*CJ OJ QJ U^J h:ZW CJ OJ QJ ^J -j h:ZW >*CJ OJ QJ U^J mH nH u(jq h:ZW >*CJ OJ QJ U^J h:ZW >*CJ OJ QJ ^J "j h:ZW >*CJ OJ QJ U^J !] ] ] ] ] ] ] ٶ h:ZW h:ZW CJ OJ QJ ^J -j h:ZW >*CJ OJ QJ U^J mH nH u"j h:ZW >*CJ OJ QJ U^J (jI! h:ZW >*CJ OJ QJ U^J , 1h / =!" #$ % F D 8sQ6gl JFIF d d Ducky < Adobe d S !1AQaq"2ґBR#7brsT5Ueu6VђCSc$t34d% !1QAq2"3aBR#sc4dbTrS$ ? xn29jʔ6o' DQ NAm6١ 5~^\ : /ƏwDx#vT /)uҢ Mnr>_s(ۏjU~ WinUߴ-㖽 htT3 H!N!<תa۱ 0[=-ry<n,q *MSiWQՐ;B5j=FTy̗TP\:T2o3PS) U\j'-e,&BO+D>9]#Lx) {RTʛo$(wTÄW,7!Ϧvк{sN *r<6й g^@ ͢1ύ a(-'z NtcQJa֚h3va\ No)m CPM {*4XIΨ! 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