Check if Address is The Same For Billing
Can Driver park in the driveway if fill pipe is less than 125 from the street?
How did you hear about us?
How is your fill pipe marked?
(Click approx. location eg. BL = back left)
Does Landlord have an account?
Are you responsible for Service?
No. of Occupants
Current Volume in Tank
Home Square Footage
Would you like automatic delivery?
Type of Heating
Steam Warm Air Forced Hot Water
Number of Zones
Is water heated by oil?
Hot water heater make
Do you have a free-standing Unit?
Do you have a tankless unit?
Is your hot water storage tank connected to your boiler?
Is your house air-conditioned?
Date of last maintenance
Schedule cleaning or ultimate inspection?
Are you interested in a service plan?
No. of Years
Previous address (if < 2 years)
Applicant #1 Signature
Applicant #2 Signature
I've read and understand the terms and conditions,
and the Peterson Customer Information Handbook.