New Customer

Email

Account Name

Phone

Billing Address

Billing City

Billing State

Billing Zip

Emergency Contact Name

Phone

Delivery Address

Delivery City

Delivery State

Delivery Zip

House/Roof Colors

Own Rent

Landlord or Caretaker

Phone

Specific Directions For Delivery/Service

Important Tank Notice

Hyde Fuel requires a full safety inspection of all fuel tanks and supply lines. Any tanks or equipment out of code will require the appropriate measures to fix the code issue before fuel products can be delivered. Please provide the best phone number or email (required fillable field for this info) to schedule this inspection. If your inspection has not be scheduled within 2 business day of completing this form, please contact our office at 518-891-3151.

I agree to appropriate measures to fix the code issue before fuel products can be delivered.

Product

Tank Size

Tank Location

Current Tank Level. Please choose:

Full 75% 50% 25% Empty

Appliances

Leave Invoice

Yes No

Automatic Delivery

Yes No **

**Hyde Fuel would not be responsible for run-outs or possible resulting freeze-ups

**New Propane Customers require a gas check by a Hyde Fuel representative.

For Propane Customers
Is your tank company owned or customer owned?

 Company Owned
 Customer Owned

We value your privacy and personal security. The numbers in this section are encrypted and not stored online.

SS# or Driver's License

Co-Applicant's Name

SS# or DL#

Applicant's Employer

Phone

Co-Applicant's Employer

Phone

Applicant Signature - 04/19/2024

Co-Applicant Signature - 04/19/2024

By providing your Social Security Number, you authorize Hyde Fuel to obtain your credit report.
If this information is not provided, your account will be placed on a Cash on Delivery basis only.
Credit terms are net 10 days from date of delivery. Any balance over 30 days will result in a finance charge (18% per annum) and suspend auto delivery and Hyde Fuel would not be responsible for run-outs or possible resulting freeze-ups.