If your spouse/roomate will use this account and sign the agreement or if you would like the income and/or credit worthiness of your spouse/roomate to be considered, please complete the following:
What is your main source of heat?
Do you use this product to heat your domestic hot water?
Would your like your tank to be automatic filled?
Or would you prefer to call us when you need fuel? (please give us 3-4 days notice to schedule your delivery)
I (We) herby authorize the delivery of various petroleum products as may from time to time be delivered at the undersigned's request or prursuant to an automatic delivery schedule.
I (We) authorize you or any credit reporting agency employed by you to investigate the references or any of the other information stated above.
I (WE) HAVE READ AND AGREED TO THE TERMS PRINTED BELOW.
I (WE) HAVE RECIEVED A COPY OF THIS APPLICATION AND AGREEMENT.
NOTICE TO THE BUYER(S): YOU ARE ENTITLED TO A COPY OF THE AGREEMENT AT THE TIME YOU SIGN. KEEP IT TO PROTECT YOUR LEGAL RIGHTS.
BUYERS SIGNATURE
PAYMENT AND FINANCE CHARGE AGREEMENT
By signing this agreement, Buyer/Lessee agrees to the following terms applicable to balances owed S.B Collins, Inc (Collins)/Jolley Associates (Jolley).
1. Payment shall be made in full within (30) days after invoiced. Provided, however, that if a Payment Plan is agreed to between Collins/Jolley and buyer, buyer sall be obligated to pay the amounts called for in the Payment Plan.
2. A finance charge, computed at the following periodic rates, will be imposed on all sums which are not paid when due:
1 1/2% per month on the first $500 (annual percentage rate of 18%)
1 1/4% per month on the excess over $500 (annual percentage rate of 15%)
(Minimum monthly charge of 50 cents for balances under $33.00)
3. If Buyers fail to make any payment when due, Collins/Jolley may, at its option with or without notice, declare any and all obligations of Buyer to Collins/Jolley immediately due and payable.
4.Buyer agrees to pay all resonable costs, including a reasonable attorney's fee, incurred by Collins/Jolley in collecting any amount owing to Collins/Jolley.
5. Collins/Jolley may makes changes in the rate's, charges and other terms of this Agreement from time to time hereafter, provided that Buyer is given at least thirty (30) days prior notice of such changes and they do not exceed established by law.
6. Once a month Collins/Jolley will furnish to Buyers a statement containing the following:
a. The unapid balance as of the beginning of the monthly period.
b. The invoices charged to buyer during the monthly period.
c. The payments made by Buyer and other credits to Buyer during the monthly period.
d. The amount of the finace charges, if any, imposed during the monthly period.
e. A reminder that Buyer may at any time pay his total balance or any part thereof.
7. Any statement, notice, demand or other communication give by Collins/Jolley shall be effiective in mailed, postage prepaid, to Buyer at the last address supplied by Buyer to Collins/Jolley.
IN CASE OF ERRORS OR INQUIRES ABOUT YOUR BILL
The Federal Truth in Lending Act requires prompt correction of billing mistakes.
1. If you want to preserve your rights under the Act, here's what to do if you think your bill is wrong or if you need more information about an item on your bill.
a. Do not write on the bill, On a seperate sheet of paper write (you may telephone your inquiry but doing so will not preserve your signs under the law) the following:
1. Your name and account number (if any)
2. A description of the error an explanation (to the extent you can explain) why you believe it is an error. If you only need more information, explain the intem you are not sure about and , if you wish, as for evidence of the charges such
as a copy of the charge slip. Do not send in your copy of the sales slip or other documentation unless you have a duplicate copy for your records.
3. The dollar amount of the suspected error.
4. Any other information (such as your address) which you think will help us identify you or the reason for your complaint or inquiry.
b. Send your billing error notice to the address on your bill which is listed after the words: "Send InquiresTo". Main it as soon as your can, but in any case, early enough to reach us within 60 days after the bill was mailed to you.
2. We must acknowledge all letters pointing out possible errors within 30 days of receipt, unless we are able to correct your bill during the 30 days. Within 90 days after receiving your letter, we must either correct the error or explain why we believe
this bill is correct. Once we have explained the bill, we have no further obligation to you even though you still believe that there is an error, except as provided in paragraph 5 below.
3.After we have been notified, beither we nor an attorney nor a collection agency may send you collection letters or take other action with respect to the amount in dispute; but preiodic statements may be sent to you, and the disputed amount can be
applied against your credit limit. You cannot be threated with damage to your credit raiting or sued, for the amount in question, nor can the disputed amount be reported to a credit bureau or other creditors as delinquent until we have answered
your inquiry. However, you remain obligated to pay the part of your bill not in dispute.
4. If it is determined that we have made a mistake on your bill, you will not have to pay any finace charges on any disputed amount. If it turns out that we have made an error, you may have to pay
fiance charges on the amount in dispute, and you will have to make up andy missed minimum or required payments on the disputed amount. Unless you have agreed that your will was correct,
we must send you a written notification of what you owe; and if it is determined that we did make a mistake in billing the disputed amount, you must be given time to pay which you normally are
given to pay undisputed amounts before any more finace charges or late payment charges on the disputed amount can be charged to you.
5. If our explanation does not satisfy you and you notify us in writing within 10 days after you receive our explanation that you still refuse to pay the disputed amount, we may report you to credit
bureaus and other creditors and may pursue regular collection procedures. But we must also report that you think you do not owe the money, and we must let you know to whom such reports
were made. Once the matter has been settled between you and use, we must notify those to whom we reported you as delinquent of the subsequent resolution.
6. If we do not follow these rules, we are not allowed to collect the first $50 of the disputed amount and fiance charges, even if the bill turns out to be correct.
7. If you have a problem with property or services purchased with a credit card, you may have the right not to pay the remaining amount due on them. if you first try in good faith to return them or
give the merchant a chance to correct the problem. There are two limitations on this right.
a. You must have bought them in your home state or if not within your home state within 100 miles of your current mailing address; and
b. The purchase price must have been more then $50.00. However, these limitations do not apply if the merchant is owned or operated by the creditor, or if the creditor mailed you the
advertisement for the property or service.
VR-6/11/10
