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New Accounts

Thank you for choosing Proulx as your energy provider. Please complete our new account form so that we can make sure that we cover all of your needs now and in the future. We appreciate your business, and our mission at Proulx Oil & Propane is to grow our business through an expanding base of satisfied customers. Required fields are denoted with a red asterisk (*).

Customer Information

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*Name:
*Home Phone:
Home Phone Type:	New
	Previous
*Work Phone:
*E-Mail Address:
Property / Assoc. Name:	(If applicable)
Mailing Address
*Mailing Address 1:
Mailing Address 2:
*City:
*State:
*Zip Code:
Current Address
	Check here if same as Mailing Address above
Current Address 1:
Current Address 2:
City:
State:
Zip Code:
Delivery Information
*Delivery Address:
*City:
*State:
*Zip Code:
*Fuel Type:	Premium Heatforce Heating Oil Renewable BioHeat Propane Metered Gas

*Tank Size:
*Tank Type:	Above Ground Below Ground
Appliances : (check all that apply)	Back-up Generator Central Heat Cook Stove Dryer Fireplace Hot Water Log Set Pool Heat Sp. Heater :       # of heaters:  Other :
Please check the location most closely related to the location of your oil fill pipe or LP tank. 11 12 1 10  9  8   2  3  4 7 6 5 Front of House
Delivery Instructions:
Credit Information
As standard procedure, in relation to federal requirement in credit inquiries, Proulx Oil and Propane does run credit checks on all of our customers to determine the amount of credit we are able to extend you. We ask that you check the box below indicating you have read and understand this fact. To complete this procedure, please also provide your social security number.  I understand that payment is due fifteen (15) days from delivery and that the delivery ticket left at delivery is the invoice. I understand that deliveries may be withheld on past due accounts. I agree to pay a monthly interest charge of 2% (24% per annum) on balances unpaid after 30 days. In consideration of Proulx Oil and Propane Inc. extending credit I personally guarantee payment when due and agree to pay collection fees and reasonable attorney fees if required to ensure payments for all deliveries.
*Social Security Number :
Automatic Credit Card Payment Option
If you would like us to bill your credit card after each delivery and service, please provide us with some financial information.
Name on Card:
Card Type:	Visa MasterCard
Card Number:
Expiration Date:
Additional Information
How did you find us?	--- Select One --- Google Facebook Yahoo Bing Billboard Newspaper Magazine Email Newsletter Radio Direct Mail Spotted Delivery Truck Other (please specify)
*Today's Date:
* Effective Date of Transfer:
Additional Comments:
Would you like to receive email reminders and special promotions from Proulx?
	Yes, please notify me No, thanks
What is nine+one?
	Why are you asking me this? (enter your answer as a number, as in six+one=7)

At Proulx Oil & Propane, we believe that safeguarding your online privacy is our responsibility. We have not, nor will we ever sell, rent or make available for use, your personal account information to any third party. Your e-mail address will be used only to e-mail reminders and early notifications of special promotions from Proulx if you choose to be notified.