Previous Address (within last 2 years)

Previous Address

Street Address City State ZIP Code

Who is responsible for products delivered?

Landlord/Owner
Tenant

Who is responsible for service work performed?

Landlord/Owner
Tenant

Fuel Type

Check all that apply.

Home Heating Oil
Propane (For Whole-Home Heat)
Propane (For Accessory Use)

Delivery Type Requested

Automatic
Other

Preferred Payment Method

30-day credit
SmartPay (monthly payments)
Electronic Funds Transfer
Credit Card

Landlord Name

Landlord Address

Street Address City State ZIP Code

Landlord Phone

Budget Customers: There is no additional cost for enrollment in the Budget Plan, however, to be eligible, the customer must not have any unpaid balances on their account. The cost of my/our fuel consumption is estimated for the season and divided into (12) equal installment payments. In the event that the cost of fuel consumption is less than the estimate, the credit balance will earn interest at a rate to be determined later until refunded or subtracted from the estimated total for the coming season before the installment payments are figured for the next season. In the event that the cost of fuel consumption exceeds the estimate, then I/we agree to pay on or before the 12th monthly installment as a part of the 12th month payment. I/We understand and agree that any default on my/our part, including but not limited to failure to make scheduled installment payments timely, will result in losing my/our status as a Budget Customer(s) and that the standard terms set forth herein shall apply. Credit Terms: Net 30 days. Finance Charges will be assessed on all balances over 30 days. This is computed by a periodic rate of 1.5% (annual pct. rate of 18%) on that portion of the previous balance over 30 days less payment and credits appearing on the statement. To avoid finance charges pay the "NEW BALANCE" within 30 days of the delivery date.

The responsible parties shall be jointly and severally liable to Griffith Energy for all obligations arising pursuant to this agreement.
I hereby give my consent to Griffith Energy to obtain a record of my credit history for the sole purpose of reviewing my credit rating before approving a credit account with said company if credit account does not already exist.
All payments are to be made payable to Griffith Energy Services, Inc. Under no circumstances should a check or money order be made payable to an employee of the Company.
If it becomes necessary to effect collection, I/we agree to pay all cost of collection inculding reasonable court costs, collection agency fees and attorney's fees in the amount of twenty-five percent (25%) of the outstanding amount due except that the minimum of such reasonable attorney's fees shall be Five Hundred Dollars ($500.00). In the event that any court proceeding is filed, all parties agree that venue shall be Howard County, Maryland.
I certify that all information provided above is correct and that the credit terms of Griffith Energy are fully understood.

Signature*

Date*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Become Our Customer

Previous Address (within last 2 years)

Service Call Offer

15% Off Heating & Cooling Service Call

General Information

Griffith Services

Learn More

Pin It on Pinterest