Credit App Test | Flynn Energy & Propane

1SECTION 1 - FOR ALL ACCOUNTS COMPLETE THE FOLLOWING PERSONAL INFORMATION

2SECTION 2 - FOR JOINT OR CO-APPLICANT ACCOUNTS: COMPLETE THE FOLLOWING ABOUT THE OTHER RESPONSIBLE PARTY

3SECTION 3 - ACCOUNT INFORMATION

4SECTION 4 - ACCOUNT INFORMATION (CONT.)

5SECTION 5 - DELIVERY LOCATION INFORMATION

6SECTION 6 - E-SIGN

Co-Applicant Name
First Last
Co-Applicant Social Security Number
Phone
Cell Phone
Email
Address
Street Address Address Line 2 City State ZIP Code
Does the co-applicant own or rent this address?
How long has the co-applicant been at this address?
Co-Applicant Current Employer
How long has the co-applicant been employed with this employer?
Co-Applicant Employer Phone

THE UNDERSIGNED ENTERS INTO THIS RESIDENTIAL CREDIT APPLICATION AND AGREEMENT WITH FLYNN ENERGY TRANSPORT, INC. (“FET”) TO EXTEND CREDIT TO THE ABOVE MENTIONED APPLICANT(S) AND FOR THE PURPOSES OF OBTAINING AND MAINTAINING A FUEL AND SERVICES ACCOUNT WITH FET UPON THE TERMS AND CONDITIONS ATTACHED HERETO WHICH ARE HEREBY INCORPORATED BY REFERENCE. THE UNDERSIGNED FURTHER REPRESENTS AND WARRANTS THE ACCURACY AND COMPLETENESS OF ALL INFORMATION PROVIDED TO FET IN THE SECTIONS ABOVE AND ACKNOWLEDGES THAT FET WILL BE RELYING ON THIS INFORMATION. THE UNDERSIGNED AGREES AND ACKNOWLEDGES THAT (I) THEY HAVE READ AND AGREE TO THE TERMS AND CONDITIONS ATTACHED HERETO; (II) TO MAKE PAYMENT IN FULL TO FET FOR ALL AMOUNTS DUE IN ACCORDANCE WITH THEIR PAYMENT TERMS; AND (III) TO PAY ALL CHARGES ASSOCIATED WITH LATE PAYMENT OR COLLECTION INCLUDING BUT NOT LIMITED TO: SHERRIFF'S FEES, COURT COSTS, AND ATTORNEY FEES. THE UNDERSIGNED ACKNOWLEDGES RECEIPT OF (I) FET'S TERMS AND CONDITIONS; AND (II) THE PROPANE SAFETY AND IMPORTANT HOMEOWNER SAFETY TIPS LITERATURE PROVIDED BY FET, BOTH OF WHICH ARE ATTACHED HERETO. THE FURNISHING OF THIS FORM OF RESIDENTIAL CREDIT APPLICATION AND AGREEMENT DOES NOT CONSTITUTE AN OFFER OR OTHER BINDING AGREEMENT OF FET. THIS AGREEMENT SHALL BE BINDING UPON THE PARTIES HERETO ONLY WHEN SIGNED AND DELIVERED BY BOTH THE UNDERSIGNED AND AUTHORIZED REPRESENTATIVE OF FET. THE UNDERSIGNED HAVE EXECUTED THIS RESIDENTIAL CREDIT APPLICATION AND AGREEMENT AS OF THE DATE SET FORTH BELOW.
Applicant Signature*
Date*
MM slash DD slash YYYY
Co-Applicant Signature
Date
MM slash DD slash YYYY

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