Apply For Credit

1Service Info

2Applicant Info

3Final Info

Prior to submitting any application to Homenergy and Propane for processing, please be sure your credit report is available for review. If you have a freeze or hold on your report, we are unable to process your application until it is lifted.
What type of customer are you*
- Commercial
- Residential
Residential Fuel products you need*
- Propane
- Heating Oil
- Kerosene
- Diesel Fuel
Commercial Fuel products you need*
- Propane
- Heating Oil
- Gasoline
- Kerosene
- Diesel Fuel
Existing Propane Appliances
- Furnace
- Boiler
- Space Heater
- Water Heater
- Fireplace
- Dryer
check all that apply
Do you own or rent?*
- Own
- Rent Location
If location is rented
Name of Property Owner/Landlord*
First Last
Account # if applicable
Landlord Phone*
Landlord Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
PROPANE EQUIPMENT REQUIRED
Tank Size/Qty
200lb 420lb 330lb 500lb 1000lb
Add the number of tanks you need for each under the tank size.
Est. Gallons/Year
Special Instructions
TERMS & CONDITIONS*
I acknowledge that I have read and understand the below terms & conditions as set forth in this agreement between MX Petroleum Corp. and mysel
Credit Approval/Account Set Up
All propane accounts must be credit approved. An authorized agent of HomEnergy, A Division of MX Petroleum Corp. (Hereafter referred to as MX Petroleum Corp.) will use the information provided to verify credit through an outside credit reporting agency. The credit application will remain on file for the duration of your time as a customer. All information provided is for MX Petroleum Corp.’s use only and will not be shared with any outside parties. Please be advised that all credit approved propane accounts will be set up with automatic delivery. MX Petroleum Corp. reserves the right to remove your account from automatic delivery at any time if you fail to abide by the terms and conditions as set forth in this agreement. If for any reason you choose to have your account removed from automatic delivery it is required that you submit a written request to our office at 33 Depot Street Saranac Lake, NY 12983.

General Terms & Conditions of Payment
MX Petroleum Corp. requires payment in full within 10 days of your delivery or prior to your next delivery, WHICHEVER COMES FIRST. No deliveries (call in or automatic) of any product will be made if there is an outstanding balance owed on the account. To the extent that purchases remain unpaid beyond agreed terms; MX Petroleum Corp. will assess finance charges or interest, whichever is applicable, at the maximum rate allowable under NY State Law. Payments received will be applied to any finance charges or interest owing on the account first with any remaining credit to be applied towards aging balance. (MX Petroleum Corp. does not accrue interest upon interest).

If payment is not received within 30 days from date of delivery, then you will receive written and/or verbal notice that the tanks will be picked up due to non-payment. Any costs and/or fees accrued due to tank pick up will be the responsibility of the customer.

If full restitution is not made on purchases within 60 days and no other payment agreement can be reached, Seller reserves the right to charge credit card on file or perform an E.F.T. payment using your bank information to secure the balance past due on account. If this option is not available, MX Petroleum Corp. also reserves the right to proceed with collections through a 3rd party agency or take civil action against you in a court of law. Any expense accrued by MX Petroleum Corp. while attempting to collect a debt owed, including but not limited to reasonable attorney’s fees and court costs, must be reimbursed to MX Petroleum Corp. by you the customer.

Lock-In Pricing/Cash Discount Terms & Conditions
Customer understands that upon execution of this agreement, MX Petroleum Corp. may enter into contracts or arrangements to obtain and secure supply of the committed gallons to supply customer at the Lock-In Price. Customer acknowledges that MX Petroleum Corp. cannot predict whether the price of fuel will go up or go down and that the Lock In Price shall apply to all customer’s required gallons during term of the Lock In Pricing even if the MX Petroleum Corp. selling price is less than the Lock In Price at the time of delivery. Should customer cancel this contract or be in default prior to the completion of the Lock-In Period, MX Petroleum Corp. may assess penalties to recover MX Petroleum Corp. losses and/or legal expenses along with restocking and termination fees.

A cash discount price of 10 cents per gallon off the charge price will be calculated on your delivery ticket invoice total (discount subject to change). This discount applies to both Lock-In and Non-Lock In pricing. After 10 days from the date of delivery, if payment has not been received the 10 cent per gallon discount does not apply. All budget accounts will automatically receive the cash price discount. CREDIT/DEBIT CARD PAYMENTS DO NOT RECEIVE CASH PRICING. PAYMENTS MUST BE IN FORM OF CHECK, MONEY ORDER, CASH OR ELECTRONIC FUNDS TRANSFER (E.F.T. INFORMATION AVAILABLE UPON REQUEST).

Propane Tank Rental Fees for Customer/Minimum Purchase Requirements
By signing this contract, you are agreeing to a minimum yearly (January 1st – December 31st) purchase requirement described below. These requirements will take effect beginning January 1st of the year following the contract date.

MX Petroleum Corp. may charge a yearly tank rental fee or a delivery fee per tank.

In the event a customer fails to meet the minimum purchase requirements, MX Petroleum Corp. reserves the right to charge a yearly rental fee of $100.00 per tank for the shortfall gallons. Account reviews will be in the month of January and any applicable rental fees will be billed at this time.

Owners/Landlords of rental properties: In the event you are the legal property owner but use the delivery location as a rental property you are responsible for notifying us of change in tenant at said location. Any deliveries made to the location without an active supply agreement on file for the current tenant will be billed to the property owner/landlord. Any unpaid product remaining in the tank at the time the tenant vacates the location will be made available for purchase to you; in the event you decide to opt out of purchasing this unpaid product MX Petroleum Corp. reserves the right to perform a pump out to recoup its costs. In the event the tenant fails to pay any balance due on his/her account resulting in the need for a tank pick up MX Petroleum Corp. will contact the property owner/landlord to allow them the opportunity to settle the debt owed and avoid tank pick up. Property owner/landlord must understand that no deliveries will be made to their property in the event their tenant owes an outstanding balance.

**If you are not the legal owner of the property on which the tank is set (tenant), you are required to pay a $150 security deposit. MX Petroleum Corp. reserves the right to retain this deposit in the event of termination/default of contract**

Termination/Default of Contract
MX Petroleum Corp. reserves the right to terminate this contract at any time for any of the following reasons:

• Fails to maintain an acceptable credit rating with MX Petroleum Corp. or is otherwise in arrears in any bill due to MX Petroleum Corp. or its service representatives; (MX Petroleum Corp. does not accept C.O.D. Propane Accounts)
• Misuse and/or damage of MX Petroleum Corp. equipment equipment
• Fails to meet minimum yearly gallon purchase requirements

In the event of termination of service whether requested by MX Petroleum Corp. or the customer, a pick up fee of $150.00 per delivery location plus a restocking fee of $1.00 per gallon for any product remaining in tanks at time of pick up will be charged to your account. If any of these fees apply, customer agrees to pay these fees within 10 days from date of tank pick up.

BUSINESS INFORMATION
Customer Name*
DBA
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Name*
Phone*
Fax
Federal Tax ID*
Principle Officer/Partner 1*
Title*
Social Security#*
Principle Officer/Partner 2
Title*
Social Security#
Bank References
Bank Name/Branch*
Account #*
Contact*
Phone*
Fax
Trade References
Oil Suppliers
Name*
Contact*
Phone*
Address
Street Address Address Line 2 City State ZIP Code
OTHER TRADE
Name*
Contact*
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name*
Contact*
Phone*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Delivery/Service Information
(All credit approved propane accounts will be set up on automatic delivery)
Consent*
I agree with the below
*Please note that if multiple locations are being serviced by MX Petroleum Corp. this agreement will be used as a blanket agreement to cover all propane tanks in use by the customer at all locations served by MX Petroleum Corp.
Delivery Address*
Street Address Address Line 2 City State ZIP Code
Select one*
- Own
- Rent
- Temporary Jobsite
If location is rented or temporary jobsite: Name of Property Owner/Landlord*
Account # if applicable
Account # if applicable
Landlord Phone*
Landlord Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
MX PETROLEUM CORP. GENERAL TERMS AND CONDITIONS*
I agree to the below.
Residential credit terms are net 30 (days) from date of service, other types of accounts will be assigned terms upon submission of an approved credit application, subject to credit limits assigned by HomEnergy, A Division of MX Petroleum Corp. To the extent that balances remain unpaid beyond agreed terms, Seller reserves the right to charge credit card on file or perform an E.F.T. payment using your bank account information for the balance past due on account if no other payment arrangement can be agreed upon. In the event that terms are not met, Buyer will lose credit privileges and any special prices or discounts in place between Seller and Buyer, and Seller will assess late payment charges or interest, whichever is applicable, at the maximum rate allowable under state law. Buyer agrees to reimburse seller for all collection expense, including attorney fees incurred in connection with the collection of delinquent amounts.

By signing below, I confirm that the information I have given in this application is complete and accurate. I authorize HomEnergy to verify this information, and I authorize the release of personal information listed above, solely for the use of credit verification by HomEnergy. In addition, I agree to all HomEnergy Terms of Payment.
MX PETROLEUM CORP. GENERAL TERMS AND CONDITIONS*
I agree to the below.
Where possible, BUYER shall agree to HomEnergy’s, A Division of MX Petroleum Corp., (Herein referred to as SELLER) Standard Agreement prior to delivery of product from seller’s truck.

TITLE: Title and risk of loss, including without limitation, risk of damage, deterioration and/or evaporation, passes from seller to BUYER when the product passes the flange or spout between SELLER’S delivery line and BUYER’S receiving connection or equipment. Whether truck, rail car, barge or other receiving equipment.

CREDIT: SELLER will issue a credit limit at its discretion after receiving and examining references and other which may be requested for the purpose of establishing credit limits. SELLER reserves the right at any time to withdraw or adjust the credit limit. If required by SELLER, the BUYER will issue security in a form and amount acceptable to the SELLER or provide a Personal Guaranty.

PAYMENTS: Credit terms of payment will be set upon completion and review of this application and will be subject to credit limits assigned. To the extent that purchases remain unpaid beyond agreed terms; SELLER will assess finance charges or interest, whichever is applicable, at the maximum rate allowable under State Law. Payments received will be applied to any finance charges or interest owing on the account first, with any remaining credit to be applied towards the aging balance.

If payment is not received within the allotted terms, SELLER the right to revoke charge status. If full restitution is not made on purchases within 60 days and no other payment agreement can be reached, SELLER reserves the right to charge any credit card on file or perform an E.F. T. payment using BUYER’S bank information to secure the balance past due on your account. If this option is not available, SELLER also reserves the right to proceed with collections through a 3rd party agency or take civil action against BUYER in a court of law. Any expense accrued by SELLER while attempting to collect a debt owed, including but not limited to reasonable attorney’s fees and court costs, must be reimbursed to SELLER by you the BUYER.

TAXES: All taxes, duties, fees or any other charges (collectively “Taxes”) that are imposed or assessed by any Federal, State, County or Local Government or Agency in respect to the purchased product will be paid to the SELLER by the BUYER. If BUYER is exempt from any taxes, fees or charges, it must provide the Seller with a proper Exemption Certificate prior to lifting any product. Failure to timely provide the proper Exemption Certificate shall automatically subject the BUYER to pay such tax, fee or charge, include any applicable interest, penalties, and/or consequential costs or fees imposed upon Seller as a result of such failure.

FORCE MAJEURE: Neither the SELLER nor BUYER is liable for failure to timely perform any of his obligation under this contract, if failure was due to impediment beyond the party’s control, including but not limited to National and International markets in fuel supply and production. The party-claiming impediment shall give facsimile notice to the other party prior to delivery time and date. The party-claiming impediment shall use all reasonable and diligent efforts and delivery shall be suspended only so long as the impediment remains, unless the parties agree to terminate their mutual obligation.

CLAIMS: Any controversy or claim regarding the quality of purchased product will be Time-Barred unless by the BUYER in writing to the Seller within ten (10) days of purchase date.

ASSIGNMENT: The BUYER cannot assign any of its product contract rights or obligations without the prior written consent of the SELLER. Seller may assign the product contract rights for the purpose of financing to its banks and/or financial institutions.

WAIVER: Any failure of the SELLER to enforce any provision shall not be deemed a waiver of the right to enforce such provisions in the future.

WARRANTY: Except as to quality, SELLER makes no warranties, expressed or implied, with respect to the merchantability of product or otherwise. The warranty of fitness for a particular purpose is expressly disclaimed. In no event shall Seller be liable for incidental, consequential or punitive damages.

To the best of my ability, the information provided is correct. I acknowledge receipt of and am authorized on behalf of my company to sign for, and agree to, these General Terms & Conditions.
PRIMARY APPLICANT INFORMATION
Name*
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Site Address (if different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
# of Years at This Address*
Phone*
Email*
Do you wish to receive invoices via email?*
Do you wish to receive statements via email?*
Social Security #*
Date of Birth*
Month
Day
Year
Drivers License #*
Drivers License State*
Drivers License Expiration Date*
Month
Day
Year
Employer*
Years at Employer*
Work Phone
Work Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is there a Co Applicant?*
- Yes
- No
CO APPLICANT
Co Applicant Name*
First Last
Co Applicant Social Security #*
Co Applicant Date of Birth*
Month
Day
Year
Co Applicant Drivers License #*
Co Applicant Drivers License State*
Co Applicant Drivers License Expiration Date*
Month
Day
Year
Co Applicant Employer*
Co Applicant Years at Employer*
Co Applicant Work Phone*
Co Applicant Work Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BANK INFORMATION
Bank Name*
Bank Account #*
MORE INFORMATION
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Directions to Site Address*
Tank Size
Tank Location*
Do you heat your hot water with oil?*
- Yes
- No
Do you heat with an alternate heat source?*
- Yes
- No
What do you heat with*
If credit approved, do you wish to be on automatic delivery?*
- Yes
- No
Additional Notes
Agree to Terms of Payment?*
- Yes, I Agree
- I Do Not Agree
General Terms & Conditions*
I agree to the below General Terms & Conditions
TERMS OF PAYMENT Credit terms are net ten (10) days from delivery, subject to credit limits assigned by MX Fuels, A Division of MX Petroleum Corp. To the extent that purchases remain unpaid beyond agreed terms, buyer will lose credit privileges and any special prices or discounts in place between seller and buyer, and seller will assess late payment charges or interest, whichever is applicable, at the maximum rate allowable under state law. Buyer agrees to reimburse seller for all collection expenses, including reasonable attorney fees incurred in connection with the collection of delinquent amounts. By checking below, I confirm that the information I have given in this application is complete and accurate. I authorize MX Fuels to verify this information, and I authorize the release of personal information listed above, solely for the use of credit verification by MX Fuels. I agree to the MX Fuels Terms of Payment.

If location is rented

PROPANE EQUIPMENT REQUIRED

BUSINESS INFORMATION

Bank References

Trade References

Oil Suppliers

OTHER TRADE

Delivery/Service Information

PRIMARY APPLICANT INFORMATION

CO APPLICANT

BANK INFORMATION

MORE INFORMATION