Apply for New Home Service Section A - Personal Information Application Type New application Existing customer applying for credit Applicant Co-Applicant Mailing Address Delivery Address (if different from mailing address) Own Rent If at above residence for less than one year, please provide previous address Name of landlord please review below regarding renters deposit Your Phone Number(s) Alternate Contact Employer How did you hear about us? Advertisement Newspaper Television Commercial Referral Other (fill in below) Section B - Credit Reference Checking Loan Savings Credit Card Have you declared bankruptcy in the last six years? No Yes Are there any unsatisfied judgements against you? No Yes Section C - Petroleum Products Information Product Type #2 Fuel Oil Kerosene Gasoline Diesel Propane Location of Existing Tank Above Ground Under Ground Basement Would you be interested in our Level Pay program? Yes, please send me information about Level Pay Existing Tank Size Current or Previous Supplier Section D - Terms Unless otherwise noted in this form, the following payment terms apply: Residential - Payment is due in full within thirty (30) days from the date of purchase. A finance charge on amounts past due after thirty (30) days will be added at the rate of 1.5% per month (APR 18%) or $1.00, whichever is greater, on the unpaid balance. Transport - Payment is due in full within terms from the date of delivery. A finance charge on amounts past due will be added at the rate of 1.5% per month (APR 18%) or $1.00, whichever is greater. Credit extended to customers residing in rental property - Customers residing in rental property, upon meeting all regular credit criteria, can receive credit terms for product delivery upon payment of a security deposit. This deposit is payable in advance and is equal to one-half the volume of the tank at the current product rate on the date of agreement. This deposit is held for twelve months. At the end of twelve months, and with a positive payment history, the security deposit is refunded to the customer in the form of a credit to the account. If the customer discontinues service prior to the end of twelve months, the security deposit will be refunded within thirty days less any outstanding charges on the customer account. This provision does not release customer from any liability for any remaining outstanding balance if security deposit is not sufficient to clear balance of the customer account. If Fuel Oil Customer: 1) Customer must provide easy access to tank and equipment. Customer agrees to indemnify and hold harmless from and against any and all claims of damage to property connected with the delivery of the fuel. Customer acknowledges that customer owned driveways and parking areas are capable of withstanding the weight of an LP/fuel delivery truck. Any damage to same is customer's responsibility. 2) Neither party hereto shall be liable to the other for any failure to perform any provision or obligation of this contract (except customer's obligation to pay for fuel delivered) if such failure is caused by or results directly or indirectly from any act of God, Federal state or municipal order, legislation or regulation, fires, floods, storms, strikes, war, accidents, interruption to or discontinuation of production, railroad embargoes, breakdown or failure of transportation facilities, preemption by any governmental agency of the products covered hereby or the facilities of either party hereto, or any other cause beyond the control of the party failing to perform. COMPANY SHALL NOT BE LIABLE TO CUSTOMER OR OTHERS FOR INJURY TO PERSONS OR DAMAGE TO PROPERTY DUE TO COMPANY'S INABILITY TO DELIVER FUEL. Company may distribute its available supply of liquefied petroleum gas to a given location or in a stated area among its customers in such reasonable manner as it may determine. 3) Customer hereby authorizes Company to full tank when Customer is not at home and to provide regular delivery service until such time as Company is notified in writing. 4) This agreement contains the entire contract between the parties as to equipment, service and delivery and supercedes all agreements, warranties or representations, oral or otherwise. This agreement cannot be changed or any of its provisions varied except in writing, signed by the Customer and accepted by the Company. Any waiver of any of the terms or conditions of this agreement shall not be deemed to be a continuing waiver of such terms or conditions or a waiver of any other terms or condition hereof. Section E - Authorization Agreement for Preauthorized (EFT) Payments if applicable I (we) authorize Davenport Energy, hereinafter called Company, to initiate debit entries to my (our) checking account indicated below and the bank named below, hereinafter called Depository, to debit the same to such account. This authority is to remain in full force and effect until the Company and Depository has received written notification from me of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to work. The undersigned hereby submits this application for the purpose of applying for a credit account with Davenport Energy, affirms that the information provided herein is true and accurate and acknowledges and accepts the provisions noted above, and further gives Davenport Energy permission to obtain a credit history now, and again in the future, if conditions warrant, using the applicants Social Security Number. Upon approval of credit, the undersigned agrees to pay promptly and within thirty (30) days (or as otherwise notified in this agreement) from the date of delivery or services rendered. If payment is not received within thirty (30) days, or as otherwise noted in this agreement, Davenport Energy may, at its option and without notice, not make a delivery, or terminate service, and remove company-owned property and gas from the delivery address. The undersigned agrees to pay any and all collection and/or attorney's fees and all legal costs incurred or obligated by Davenport Energy in enforcement and/or collection of this agreement. The undersigned understand that a late payment charge in the amount of 1.5% per month (APR 18%) or $1.00, whichever is greater, will be added, if payment is not received within thirty (30) days, or as otherwise noted in this agreement, and shall continue each 30 days thereafter, until the past due balance is paid in full. Davenport Energy will charge the maximum allowable fee for any check returned for insufficient funds. Further, the undersigned agrees to pay this account and personally guarantees and stands for the credit and all lawful charge of the above named applicant made to Davenport Energy. Signature I have read and agree to the terms listed above and the Davenport Terms and Conditions. I understand and agree that this application is being submitted electronically via the Davenport website at www.davenportenergy.com and that my typed name below shall constitute my signature on this application. My signature indicates that I agree to the Account Terms and Conditions as displayed online and recorded in this document. I understand that I will automatically receive a copy of this electronic application via email upon submission. Electronic signature Co-Applications Electronic signature If a co-applicant is named above, then a signature is required. Your application will not be processed until signatures for all applicants have been provided. Submitting this form Type the characters shown in the box provided and click submit.