New Customer Signup Process - Ford's Fuel and Propane

Welcome to Ford’s Fuel and Propane!

Thank you for choosing us as your fuel and propane provider. We understand how stressful turning a house into a home can be. Whether you’re building or improving, it’s your home, and we want to make certain you have the best experience possible. So, before we get started, help us get to know you a little better.

The Ford’s Fuel and Propane Family

Step 1 of 14

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What type of account will this be?*
- Residential
- Commercial
Please select the ONE service area that best describes your service area property location:*
- Loris
- North Myrtle Beach
- Oak Island
Sales Person*
First Name*
Middle Name
Last Name*
We understand you wish to provide your Social Security number, but not via this form. Please contact your location office AFTER you have submitted your form completely and we will take your confidential information.
I will not provide my Social Security
- No
Please Note. As a utility and/or service provider, we request your Social Security to create a credit account. By not providing us your social security, and without a line or credit, you will be a Cash Before Delivery customer. Thank you.
Social Security Number*
Date of Birth*
Email*
Phone*
Are You Interested In Receiving Invoices & Statements By Email?*
- Yes (please add billing@fordsfuelandpropane.com to your safe sender list)
- No
Please Note: There is an additional $2.50 statement charge on paper statements should you elect to not receive your statements by email.
Physical Address of Service Location*
Street Address Address Line 2 City State ZIP Code
Mailing Address
Same as Service Location

Street Address Address Line 2 City State ZIP Code

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OWNERS, PARTNERS OR OFFICERS
Name
First Last
Birthdate*
Email*
Title*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How many owners or partners will you be inputting on this form?
1. Name
First Last
1. Birthdate
Month
Day
Year
1. Title
1. Address
Street Address Address Line 2 City State ZIP Code
2. Name
First Last
2. Birthdate
Month
Day
Year
2. Title
2. Address
Street Address Address Line 2 City State ZIP Code
3. Name
First Last
3. Birthdate
Month
Day
Year
3. Title
3. Address
Street Address Address Line 2 City State ZIP Code
4. Name
First Last
4. Birthdate
Month
Day
Year
4. Title
4. Address
Street Address Address Line 2 City State ZIP Code
5. Name
First Last
5. Birthdate
Month
Day
Year
5. Title
5. Address
Street Address Address Line 2 City State ZIP Code
6. Name
First Last
6. Birthdate
Month
Day
Year
6. Title
6. Address
Street Address Address Line 2 City State ZIP Code

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BANKING INFORMATION
Bank Name*
Contact Person*
Phone*
Account Number
Account Type*
- Savings
- Checking
- Other
Bank Address*
Street Address Address Line 2 City State ZIP Code

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AGREEMENT
At Fords Fuel and Propane, we're just like any other utility company. Before extending a line of credit we need to obtain your credit report. By signing...
We certify that all the information in this form is correct. We fully understand your credit terms and agree to prompt and timely payments. By submitting this application, we authorize Ford’s Fuel Service, Inc. and Ford’s Propane Gas, Inc. to obtain business and/or personal credit and/or financial information to the Applicant and its principals. In consideration of the extension of credit by Ford’s Fuel and Propane, Inc., to , the above named company, the undersigned individual Guarantor(s) unconditionally guarantee(s) full and prompt payment of all indebtedness of the Company, now due or due in the future, including finance charges and attorneys fees. Guarantor(s) waive(s) notice of protest, presentment, demands, notice of dishonor, notices of any extension to the Company to repay the debt, notice of any compromise of the Company’s obligations or any other notices to which the Guarantor(s) might otherwise be entitled.
Name of Guarantor*
Guarantor’s Signature*
Date*
MM slash DD slash YYYY
Guarantor’s Signature
Date
MM slash DD slash YYYY

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CREDIT REFERENCES
1. Company Name
1. Contact
1. Phone
1. Fax
1. Address
Street Address Address Line 2 City State ZIP Code
2. Company Name
2. Contact
2. Phone
2. Fax
2. Address
Street Address Address Line 2 City State ZIP Code
3. Company Name
3. Contact
3. Phone
3. Fax
3. Address
Street Address Address Line 2 City State ZIP Code

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EMPLOYMENT INFORMATION
Employment Status
- Retired
- Unemployed
Current Employer*
Length of Employment
Employer Phone Number*
Employer Address*

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CO-APPLICANT (FOR JOINT ACCOUNTS)
No Co-Applicant
- No
Co-Applicant Name
First Last
Co-Applicant DOB
Month
Day
Year
Co-Applicant Email
Home Phone
Cell Phone
Address
Street Address Address Line 2 City State ZIP Code

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FORD’S FUEL SERVICE and/or FORD’S PROPANE GAS. INC.

CUSTOMER EQUIPMENT AGREEMENT
At the request of the customer, hereinafter called "Customer", Ford’s Fuel Service, Inc. and/or Ford’s Propane Gas, Inc., hereinafter called "Ford’s", agrees to provide the customer, unless purchased, the equipment listed on the estimate, hereinafter called "Equipment", subject to the following conditions:
1. Either party may terminate this agreement at any time by giving the other party thirty (30) days prior written notice.
  1. If Customer wishes to terminate:
2. Ford’s may terminate this equipment immediately and without notice, if any of the following events occur:
3. Equipment provided by Ford’s shall be used for the storage and handling of products sold by Ford’s. The equipment is and shall remain the property of Ford’s. The installation charges provided herein shall not be considered a deposit and will not be refunded upon termination of this agreement.
4. Equipment provided by Ford’s shall not be removed from the location listed in the Customer Packet. If the equipment fails to function or otherwise needs repairs or adjustment, Customer agrees to notify Ford’s. Ford’s will make repairs or adjustments which, in its opinion, are necessary; provided however, the need for such repairs or adjustment is not occasioned by negligence, misuse or servicing by the Customer or anyone not authorized by Ford’s, such repairs and adjustments shall be at the Customer’s expense. All appliances to be used and served by the equipment shall be installed by a certified technician experienced in making gas tight installations and connections. Customers assume full responsibility for all connections made to Ford’s lines for the installation of any appliance unless Customer affords Ford’s an opportunity to inspect and supervise such installation and pays Ford’s its regular service charge. The Customer shall be responsible for any loss or damage to the equipment, unless caused by an act from God. Customer shall comply with all regulations and instructions supplied with or attached to the equipment.
5. The installation charge of this agreement is based upon an estimate and is subject to change, depending upon alternate sums such as, but not limited to, appliances, labor and materials.
6. Customer certifies they will not hold Ford’s or any of its agents/contractors liable for any damages done to their property for the sole purpose of installation, and/or delivery of product.
7. If equipment is provided by Ford’s, Customer agrees to pay the Equipment Maintenance Fee. This fee covers any cost associated with keeping the tank in working order.
8. Customer understands, if their account becomes delinquent, they will be responsible for any and all collection/court costs in addition to all account balances, and any additional related fees, including the maximum allowable interest rate by the applicable state.
9. Customer shall indemnify and hold harmless Ford’s, its successors and assigns, of and from any and all liability for claims for loss, damage or injury to persons or property (including, but not by way of limitation, Customer, his agent, servants and employees and members of his household or other occupants of the premises upon which the equipment is located) caused or occasioned by any leakage, fire or explosion of any of the products stored in said equipment or contained or drawn through said equipment or any attachment or appliance used, connected, installed or furnished therewith which shall occur before notice to Ford’s could have repaired or which shall occur by reason of failure of Customer to shut off gas or other petroleum product in accordance with such regulations or otherwise to observe such regulations or instructions which shall be the result of negligent damage to or misuse of the equipment by the Customer.
10. This agreement is not assignable or transferable by Customer without the written consent of Ford’s.
11. This agreement contains the entire contract between parties as to the equipment and supersedes 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 Ford’s. Any waiver of any of the terms or conditions of this agreement shall not be deemed to be a continuing waiver or such terms or conditions or a waiver of any other term or condition hereof.
Customer acknowledges a receipt of this agreement, and all the regulations and instructions referred to herein.
Date*
MM slash DD slash YYYY
Signature*

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At Fords Fuel and Propane, we're just like any other utility company. Before extending a line of credit we need to obtain your credit report.
By signing this application, I hereby give Ford's Fuel Service, Inc &/or Ford's Propane Gas, Inc. permission to obtain a copy of my credit report.
Account status is subject to change without notification due to non-payment or credit history.
Opt-out of Credit Check
- YES
If you do NOT want Ford's Fuel and Propane to run a credit report, and do not wish to receive a line of credit, please check this box. By checking this box, you agree to become a Cash Before Delivery customer and will need to fill out a Bank Draft Form and/or Will Call Form.
Signature of Applicant*
Date*
Month
Day
Year
Print Co-Applicant's Name
Date
Month
Day
Year
Signature of Co-Applicant:

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Cash Before Delivery
Dear Valued Customer,
Thank you for allowing us to be your LP Gas supplier. We look forward to providing you with uninterrupted service for many years to come. In order to provide top quality service we need your cooperation.
You are receiving this notice because your account is either, C.B.D. (Cash Before Delivery), Will Call, or 100 lb. cylinder customer.
If your account is C.B.D. (Cash Before Delivery), we require you to keep enough money on your account to pay for at least 50 gallons, which will be delivered the next time we’re on your route. If you fail to keep an adequate amount of money on your account we will not stop to check your tank. However, if you have to have gas you can choose to pay for a special trip, $90 if you pay in the office or online during business hours, $150 after hours.
*Money must be paid in advance in order for a special delivery to be made.
If your account is Will Call, we need at least six weeks’ notice to insure the delivery before you run out of gas. However, if you have to have gas you can choose to pay for a special trip, $90 if you pay in the office or online during business hours, $150 after hours.
*You must have a current charge account established.
If you have a 100 lb. cylinder, we will fill these cylinders only once a year, in the beginning of the heating season. However, if you have to have gas you can choose to pay for a special trip, $90 if you pay in the office during business hours, $150 after hours.
*You must have a current charge account established.
Please plan ahead for the next heating season. Take advantage of our budget program, this plan gives you 11 equal payments based on your previous usage. You can also pay for your deliveries online or have it drafted. We prefer that you always have the gas that you need and at the best possible price, but in order for this to happen you must sign up for the budget plan.
Thank you
PLEASE INITIAL:*

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I do swear, I own the tank on my property. By signing below, I declare this information is true and releases Ford’s Propane Gas Inc. from any liabilities.
Print Name*
Date*
MM slash DD slash YYYY
Signature*

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DIRECT PAYMENT AUTHORIZATION
This form is used for Ford’s Fuel Service, Inc and Ford’s Propane Gas, Inc (ACH) payment(s). The information being collected on this form will be used by our office to draft payment(s), by electronic means. Failure to provide the requested information may delay or prevent the draft of payment through the ACH Payment System. The customer will be charged a $30 processing fee if the draft is unable to process. Ford’s Fuel Service, Inc and Ford’s Propane Gas, Inc requests to be notified immediately regarding any change occurring at the financial institution that may delay or prevent the draft of scheduled payments. Please attach VOIDED check to bottom of page. Please inform the office when you wish to cancel your ACH in writing (letter or email).

NOTE: C.O.D. CUSTOMERS WILL DRAFT 1 DAY FROM BILLING!

This Section to be completed by Individual or Business Shareholder/Owner
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FINANCIAL INSTITUTION INFORMATION
Name
Address
Street Address Address Line 2 City State ZIP Code
Routing Number (see sample above)
Account Number (see sample above)
Type Of Account
- CHECKING
- SAVINGS
Phone

INDIVIDUAL/BUSINESS INFORMATION
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Date
MM slash DD slash YYYY
Printed Name/Owner Name
Title
Signature
By signing this form, you are certifying that the above information is true and correct and that you have lawful use of the given banking account for us to access and draft monies from.

Please upload an image of your void check
Accepted file types: jpg, png, pdf, gif, Max. file size: 50 MB.

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Step 1 of 14

Business Credit Application

OWNERS, PARTNERS OR OFFICERS

BANKING INFORMATION

AGREEMENT

CREDIT REFERENCES

EMPLOYMENT INFORMATION

CO-APPLICANT (FOR JOINT ACCOUNTS)

FORD’S FUEL SERVICE and/or FORD’S PROPANE GAS. INC.

CUSTOMER EQUIPMENT AGREEMENT

Cash Before Delivery

DIRECT PAYMENT AUTHORIZATION

FINANCIAL INSTITUTION INFORMATION

INDIVIDUAL/BUSINESS INFORMATION

Our Locations

Loris

North Myrtle Beach

Oak Island