Retail Credit

NOTICE: I HEREBY AUTHORIZE YOU OR ANY CREDIT REPORTING AGENCY EMPLOYED BY YOU TO INVESTIGATE THE REFERENCES HEREIN LISTED OR ANY OF THE OTHER INFORMATION STATED ABOVE TO DETERMINE MY QUALIFICATIONS FOR A CREDIT ACCOUNT.

CREDIT APPLICATION AND CONTRACT TO PURCHASE FUEL OIL THROUGH TEMPERATURE CONTROL DELIVERIES AND/OR PLUMBING RELATED SERVICE

Corporate Acct. Title (if applicable)

Contact Information

Name(Required)

First Last

Date of Birth

Spouse's Name

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Years There

Do you rent or own?

Rent

Own

Phone(Required)

Email(Required)

Previous Address

Address

Street Address Address Line 2 City State ZIP Code

Rental Information

Landlord's Name

First Last

Landlord's Address

Landlord's Phone

Years There

Your Employer Information

Your Employer

Address

Street Address Address Line 2 City State ZIP Code

Your Business Phone

Years There

Spouse's Employer Information

Spouse's Employer

Address

Street Address Address Line 2 City State ZIP Code

Spouse's Business Phone

Years There

Previous Fuel Supplier

Name(Required)

Address(Required)

Heating

Tank Size(Required)

Gallons in Tank(Required)

Summer Hot Water

Burner Maker

Special Instructions

NOTICE TO BUYER(S):

DO NOT SIGN BEFORE YOU HAVE READ AGREEMENT.
YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AND THE INFORMATION REGARDING YOUR RIGHTS TO DISPUTE BILLING ERRORS.

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and answer questions about your credit experiences with me.

Consent(Required)

I have read and agree to the credit terms shown below and will print and retain a copy of such credit terms.(Required)

RETAIL CREDIT AGREEMENT

Delivery - We will deliver, subject to availability, fuel oil at our established price which is determined at the time of delivery. Deliveries will be made to you at the address shown on this agreement on an automatic delivery basis according to a Weather Controlled Degree Day System unless you have requested to call for your oil or our credit department has notified you that you must call for your oil. If your account is established as a will call delivery type, then we require 48 hour notice to arrange for a delivery.

Payment - A metered ticket will be left or mailed to you after each delivery. The ticket will show the number of gallons delivered and the price per gallon. A few days after delivery you will receive a price extended invoice which is to be paid within 30 days. If other payment terms are required by our credit department you will be notified by them through written notification or telephone. If you are on a budget plan then the invoice will indicate that you are to pay only your budget payment and the invoice should be retained for your records. If you maintain a service contract with us or if you require chargeable service calls for repairs or maintenance these will be billed to your oil account and require the same method of payment as your deliveries which are established by our credit department.

Statement - If you have a past due balance on your account we will send you a statement which will show the past due amount as well as your current month's purchases, the LATE FEE, and the time in which payment should be made.

Late Fees - On balances of 30 days or more we will compute a late fee at the following rate: 1.5% per month (equivalent to an ANNUAL PERCENTAGE RATE OF 18% per annum).

Default and Collection Costs - You will be in default if you do not pay a balance on time, file for bankruptcy, or make an assignment for the benefit of creditors. Default means we can demand immediate payment of the full balance. If we refer collection of the balance to an attorney or collection agency, you will be liable for all reasonable fees incurred plus court costs and expenses.

Irregular Payment and Delay in Enforcement - We can accept later payments or checks and money orders marked \"payment in full\" without losing any of our rights under this agreement. We can also delay in enforcing our rights under this agreement without losing them.

Amendment or Changes - We can change this agreement including LATE FEE and the ANNUAL percentage rate, at any time, provided we give you at least 30 days' notice before beginning of the billing period in which the change becomes effective.

Cancellation - We or you can cancel your account at any time on with 30 days written notice. You agree to remain responsible for payment for all deliveries or services made before the 30 day period expires. We also have the right to cancel your account without notice if you fail to make payments on time.

Liability - We are not responsible for damage or losses caused by failure to make delivery due to labor shortage, strikes, or to conditions beyond our control in the event of DEFAULT; we do not deliver oil as a result of DEFUALT, we will not be liable for any damages in either direct or indirect manner.

Tenant Policy - It is our company policy to require a deposit to be held in a non-interest bearing account until such time that the account is closed. Once service is terminated, the deposit will be refunded or applied to any outstanding balance remaining on the account.

What to Do If You Think You Find a Mistake on Your Statement

If you think there is an error on your statement, write to us at:

Hirsch Fuels, Inc.

508 Wheeler Road

Hauppauge, NY 11788

You may also contact us on the Web: hirschfuels.net

In your letter, give us the following information:

Account information: Your name and account number

Dollar amount: The dollar amount of the suspected error

Description of Problem: If you think there is an error on your bill, describe what you believe is wrong and why you believe it is a mistake.

You must contact us within 60 days after the error appeared on your statement.

You must notify us of any potential errors in writing [or electronically]. You may call us, but if you do we are not required to investigate any potential errors and you may have to pay the amount in question.

While we investigate whether or not there has been an error, the following are true:

We cannot try to collect the amount in question, or report you as delinquent on that amount.

The charge in question may remain on your statement, and we may continue to charge you interest on that amount. But, if we determine that we made a mistake, you will not have to pay the amount in question or any interest or other fees related to that amount.

While you do not have to pay the amount in question, you are responsible for the remainder of your balance.
We can apply any unpaid amount against your credit limit.

Your Rights If You Are Dissatisfied with Your Credit Card Purchases

If you are dissatisfied with the goods or services that you have purchased with your credit card and you have tried in good faith to correct the problem with the merchant, you may have the right not to pay the remaining amount due on the purchase.

To use this right, all of the following must be true:

The purchase must have been made in your home state or within 100 miles of your current mailing address, and the purchase price must have been more than $50. (Note: Neither of these are necessary if your purchase was based on an advertisement we mailed to you, or if we own the company that sold you the goods or services.)

You must have used your credit card for the purchase. Purchases made with cash advances from an ATM or with a check that accesses your credit card account do not qualify.

You must not yet have fully paid for the purchase.

If all of the criteria above are met and you are still dissatisfied with the purchase, contact us in writing [or electronically] at:

Hirsch Fuels, Inc.

508 Wheeler Road

Hauppauge, NY 11788

You may also contact us on the Web: hirschfuels.net

While we investigate, the same rules apply to the disputed amount as discussed above. After we finish our investigation, we will tell you our decision. At that point, if we think you owe an amount and you do not pay we may report you as delinquent.

Today's Date

Buyer's Signature(Required)

Please type your name in the box above.

Buyer's Signature

Please type your name in the box above.

Retail Installment Credit Agreement

Contact Information

Previous Address

Rental Information

Your Employer Information

Spouse's Employer Information

Previous Fuel Supplier

Heating