413 663-6653

We go beyond price per gallon!

Customer Application

Loan Application

Personal Information

For identity security reasons, your application will not be processed until we can reach you via phone to gather your SSN

Personal Information

Mailing Address

Service Address

Employer/Military Info

ACKNOWLEDGMENT AND CONSENT: I certify that the above information is complete and accurate to the best of my knowledge. Creditors receiving this application will retain the application whether or not it is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I authorize the creditors to obtain credit reports about me on an ongoing basis during this credit transaction and to check my credit and employment history on an ongoing basis during the term of the credit transaction. If this application is approved, I authorize the creditor to give credit information about me to its affiliates.

By clicking on the "Submit" button at the bottom of the page, you agree to the terms of service outlined here.

We will call you personally for your SSN information to protect your identity.


Customer agrees to pay all fees, rates and charges within 15 days of the invoice date to H.A. George and Sons Fuel Corp. If customer fails to pay any fees, rates and charges when due, H.A. George may add a finance charge of 1.5% per month (18% annually) to all 30 day past due balances. H.A. George reserves the right to require payment in advance. If H.A. George files suit against Customer to enforce any of the terms and conditions of this Agreement or to recover possession of any of its equipment, the Customer shall pay H.A. George reasonable cost, including attorney's fees, to the maximum extent permitted by law. Under no circumstances will a credit report be directly or indirectly accessed by, or passed on to, any other business entity or individual unrelated to H.A. George and Sons Fuel Corp. or be used for any other permissible purpose other than for evaluating the credit worthiness of new customers to extend net 30 day credit for the purchase of propane and/or heating services.

I/We fully understand your credit terms and agree to the proper payment of extended credit. I/We hereby certify that the facts set forth in the above application are true and complete to the best of my/our knowledge. You are herby authorized to make any investigations concerning my financial standing and/or credit record through any investigative or credit agencies.

If this form is not filed or returned than the account will be COD or deliveries held until information is obtained.

By checking this box you agree that you have read and understand the terms above:

Before submitting please make sure of the following

  • All necessary information has been filled out.
  • All information is error-free
  • All information is correct and fraud-free.
  • For Fraud Prevention purposes, we have recorded your IP Address & the time of your submission.