Peterson Preferred Customer Application

    Applicant Name

    SS Number

    Phone*

    E-mail*

    Delivery Address

    City

    State

    Zip

    Check if Address is The Same For Billing

    Billing Address

    City

    State

    Zip

    Delivery Remarks

    Special Instructions

    Can Driver park in the driveway if fill pipe is less than 125 from the street?
    YesNo

    How did you hear about us?

    How is your fill pipe marked?

    Fill Location:
    (Click approx. location eg. BL = back left)


    Complete If You Are a Tenant

    Landlord's Name

    Phone

    Does Landlord have an account?
    YesNo

    Account No.

    Landlord's Address

    City

    State

    Zip

    Are you responsible for Service?
    YesNo

    Delivery Information

    Tank Size

    No. of Occupants

    Current Volume in Tank

    Home Square Footage

    Would you like automatic delivery?
    YesNo

    Heating System Information

    Type of Home Heating Fuel
    Clean HeatBioHeatWinter BlendKeroseneI Don't Know

    Type of Heating
    SteamWarm AirForced Hot Water

    Number of Zones

    Is water heated by oil?
    YesNo

    Hot water heater make

    Do you have a free-standing Unit?
    YesNo

    Do you have a tankless unit?
    YesNo

    Is your hot water storage tank connected to your boiler?
    YesNo

    Furnace/Boiler make

    Is your house air-conditioned?
    YesNo

    Date of last maintenance

    Schedule cleaning or ultimate inspection?
    YesNo

    When?

    Are you interested in a service plan?
    YesNo

    Credit Information

    Applicant 1:

    Employer

    No. of Years

    Phone

    Previous address (if < 2 years)

    Applicant 2 (if applying jointly):

    Employer

    No. of Years

    Phone

    Previous address (if < 2 years)

    Applicant #1 Signature

    Date

    Applicant #2 Signature

    Date

    I've read and understand the terms and conditions,
    and the Peterson Customer Information Handbook.