Account Application

The following form is submitted over a secure connection and is encrypted for your security. If you would prefer to fill out a paper application, you can download, print and complete the form here, then mail it to Gary's Fuel Service, 1441 Castine Rd., Penobscot, ME 04476

General Definitions, Terms & Conditions

Automatic Delivery Agreement

Please enter the following information to start the application process. Be sure to provide complete and accurate information.

Applicant Information

Full Name:

Date of Birth:

Email Address:

Home Phone:

Cell Phone:

Mailing Address:

City:

State:

Zip:

Delivery / Service Address:

City:

State:

Zip:

Rent or Own?

Landlord or Bank Name:

Phone:

Specific Directions:

Heated Sq. Footage:

# Of Stories

# Of People

If you have a generator, what is the KW rating?

Have you ever had an account with Gary's Fuel Service?

If Yes, when was it closed?

Account #

Credit Card # (VISA, MasterCard or Discover)

Exp. Date:

Current Employer:

How Long?

Address:

Phone:

Nearest Relative (not living with you):

Address:

Phone: