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S&D Petroleum

We Make Warm Friends and Keep You Fueled

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Residential New Customer Agreement

You are here: Home / Become A Customer / Residential New Customer Agreement

Residential New Customer Agreement

"*" indicates required fields

Personal

New Customer Name*
New Customer Date of Birth*
Second New Customer Name (Optional)
Second New Customer Date of Birth (Optional)
Mailing Address*
911 Physical Address*
Current Housing Status*
Have you been at your current address for fewer than 10 years?*
Previous Address*
If you have moved in the last 10 years, please enter previous address.

Employment

Credit Reference

Fuel Information

Products you will be purchasing:
Gasoline
LPG/Propane
Fuel Oil
Kerosene
Farm Diesel
Clear Diesel
Product Usage check all that apply
Product Usage check all that apply
Method of Delivery*

Tank Information

Fuel Oil, Kerosene, Diesel, and Gasoline
Notice: a required fuel tank inspection must be done before or at the time of the first delivery.
Tank Shape
Inside Tank
Outside Tank

Propane
Will we need to schedule an appointment to have Propane tanks set?

Delivery Information

Attention: if a secondary heating source is in use at this location, such as a pellet or wood stove, you are responsible for run-outs — even if you have signed up for automatic delivery.
Will you need delivery once your account is established?
Date of Last Delivery
Current Level in Tank

Last Supplier

How did you find out about us?*

How did you find out about us?*

Why did you choose us?*

Why did you choose us?*

Other Products & Services

Other Products & Services
Would you prefer paperless billing?

3rd Party Notice (Optional)

If for any reason you are unable to respond to a notice of termination of fuel deliveries because of unpaid balances, you can choose a friend, relative, church group, community organization, or Social Services agency to be informed. Your third party will NOT be responsible in any way for your bill. If you wish to take advantage of this service, fill in the name and address of your 3rd Party.

Contract*

Contract*
NOTICE TO BUYER(S):

A. DO NOT SIGN BEFORE YOU READ AND AGREE TO OUR TERMS AND BILLING AGREEMENT

B. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AND THE INFORMATION REGARDING YOUR RIGHTS TO DISPUTE BILLING ERRORS. SHOULD YOUR ACCOUNT GO FOR COLLECTIONS OR TO AN ATTORNEY, YOU, THE ACCOUNT HOLDER, AGREE TO PAY ANY REASONABLE FEES PERTAINING TO THE COLLECTION OF THE ACCOUNT.

Notice: By submitting this form, I hereby authorize you or any credit reporting agency employed by you to investigate the references herein listed or any of the other information stated above to determine my qualifications for a credit account.
*

Paper Application

Residential Customers, if you’d prefer to print a form, fill it out and mail or submit in person:
New Customer Application PDF

Commercial Customers apply here

Related Pages

  • Fuels
  • Services
  • Fuel Delivery Info
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About Us

  • Since 1935 S & D Petroleum has proudly met the energy needs 24/7 of our friends and neighbors in Cincinnatus, Willet, Whitney Point, Marathon and surrounding communities with great service and a smile.  Read More
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Become a Customer

  • Online E-Form
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Office Hours

  • 7:30am – 4:30pm Mon – Fri
    Closed Saturday – Sunday

Connect with Us

  • 2761 State Highway 26
    Cincinnatus, NY 13040
  • 607-863-3600
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