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 and print the form here then mail it to Gary’s Fuel Service, 1441 Castine Rd., Penobscot, ME 04476

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

Applicant Information

Applicant Full Name:

Social Security #:

Phone Number:

Birthdate:

Mailing Address:

City:

State:

Zip:

How Long?

Email Address:

Cell Phone:

Credit Card #

Exp. Date:

Current Employer:

Address:

Phone:

How Long?

Nearest Relative:

Relationship:

Address:

Phone:

* Relative must not reside in the same household.

Rent or Own?

Monthly Payment:

Name & Address of Landlord or Mortgage Bank: