Home » Contact » Customer Credit Application

Customer Credit Application

Join the Dale Gas & Oil family

Make getting your propane or heating oil easy! Fill out the credit application form below for a residential fuel account.

Type of Account Requested(Required)

Budget

Net 30

Name(Required)

First Last

Email(Required)

Phone(Required)

Employer

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Phone Number

Years Employed

(Complete if joint account)

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Own or Rent?

Own

Rent

(If different from above)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Fuel Type

Number of Tanks

Tank Size (Gal.)

Estimated Annual Usage