Heating Oil | Propane | Service | Installations

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Main Office: (508) 528-0225

241 Cottage St. Franklin MA 02038

Customer Information Form

 

 

General Information

Please enter your date of birth as mm//dd/yyyy

Billing Address
Delivery Address
(If different from billing address)
Heating/Air Conditioning System Information
FHW FWA
STEAM HYDRO AIR
Electric Gas
Tankless Oil - Direct
Oil - Indirect
Front Right
Left Back

Please indicate where the fill location is located if you were facing your property's front entrance.

Pick a date
Credit Application

Please select one.

Please indicate how many years you have owned your home?

Upon Receipt of Invoice Master Card
Visa Discover

mm/yyyy

xxxxxxxxxx (no dashes)

Co-Applicant Information
The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize Benny's Energy and affiliated companies to obtain credit data from any credit agency. In addition, I/We hereby authorize Benny's Energy to deliver heating oil to my home on automatic delivery.
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