Residential Charge Account Application

fields marked with (*) are required fields
Corporate Account Name (if applicable)
Name(*):
Title: Mr. Mrs. Ms.
Current Street Address(*):
City(*): State(*):
Zip Code(*):

Home phone(*):
Cell phone(*):
E-mail Address

Former Address (if at current address for less than 3 years):
City: State:
Zip Code(*):

How long at current address?:
At Current Address, do you Own or Rent (check one)
If you Rent, Landlord's Name and Address:
How long at previous address?:
At Previous Address, did you Own or Rent (check one)
If you Rented, what was your Landlord's Name and Address:
Social Security Number(*)
Name of Previous Oil Supplier (if applicable):
Your Employer Name:
Your Employer Address:
Your Employer Phone:
Your Monthly Income: $
Checking Account Bank Name:
Checking Account Bank Address:
Checking Account Number:
Co-Applicant's Name:
Co-Applicant's Phone (if different from your own):
Co-Applicant's Social Security Number(*)
How did you hear of us?

By submitting this application, I authorize Mike & Son's Oil to verify the information on this application and to receive and exchange information about me including requesting reports from consumer reporting agencies. I understand that an account may not be established if I do not meet applicable criteria relating to my creditworthiness.

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In case of errors or inquiries about your bill
Send your inquiry in writing to Mike & Son's Oil Service, Inc., 8 Safford St., Ipswich, MA 01938. Do not write on your bill. On a separate sheet of paper, write:

1. Your name and account number (if any)
2. A description of the error and why (to what extent you can explain) you believe it is in error, and
3. The dollar amount of the suspected error

Send inquiry so that we may receive it within 60 days after the bill was initially mailed to you. You remain obligated to pay the parts of your bill that are not in dispute, but you do not have to pay any amount in dispute during the time the Creditor is resolving the dispute. During the same time, the Creditor may not take action to collect disputed amounts or report disputed amounts as delinquent.

In compliance with Massachusetts General Law Chapter 93C your letter will be acknowledged within 14 days of receipt and handling conducted within 60 days or a maximum of 120 days if further correspondence about hte matter is necessary.

Finance Charges
Regular Accounts: There will be a finance charge computed by a periodic rate of 1 - 1/2% per month for a balance existing after thirty (30) days from the closing date, which is an ANNUAL PERCENTAGE RATE of 18%.

Budget Accounts: No finance charge when payments are made inaccordance with budget credit terms.