A Better Service COmpany
74 Massabesic St
Manchester, New Hampshire 03103
Phone: 603-669-4827
Charge Account Application
Name *:
Co Applicant :
Phone *:
Street Address *:
Apt # :
City *:
State *:
Zip Code *:
Own/ Rent *:
Name of Bank *:
Present Supplier :
Employer *:
Occupation *:
Work Phone *:
Co Applicant Employer :
Co Applicant Occupation :
Co Applicant Work Phone :

Delivery Information:

Instructions :
House Color *:
Tank Size *:
Location of fill pipe *:
Use of Oil *: Heat Heat and Hot Water
Type of delivery: *: Automatic Delivery I Will Call

Please read before submitting:

I (we) hereby authorize you or any credit reporting agency employed by you to investigate the references listed herein or any of the other information stated above to determine my (our) qualifications for a credit account. I(we) authorize you to report your credit experience regarding me(us). I (we) further state that all information supplied by me(us) is true and accurate, monthly rate of 1.5% will be applied to any unpaid balances (annual rate of 18%) exceeding 30 days. I (we) will be responsible for any reasonable collection or attorney fees resulting from failure to pay for services/product rendered.

Do you accept the above Terms and Conditions? To submit you must accept this agreement and select 'I Accept' below: