PROUDLY SERVING:

  • Darien
  • Fairfield
  • Greenwich
  • New Canaan
  • Norwalk
  • Stamford
  • Weston
  • Westport
  • Wilton

Credit Application

New Account Application

Welcome to Dominick! Use the form below to apply for a new account today. If you have any questions, please call the office.

Already a customer?
If you are an existing customer updating an account to add oil or propane, please enter your account number in the text box below. Note, if you need to update your delivery address, please call the office.

Due to the Covid-19 pandemic we would like to minimize the time anyone is within your home. Please take a moment to take photos of your equipment and oil tank or tanks. This will be requested within the application, but will not be required for us to help you. By doing so, it may allow us to make your fuel delivery before we send our technician to your home for a system evaluation. The review of the oil tank and system is our policy before we make any deliveries to your home.

NOTE: Unfortunately due to the stringent safety policies we have in place on propane systems, we can not deliver propane until we do a thorough safety check of the system so the pictures only work for the oil systems.
* = Required Field

Customer Information

* Customer Name:
* Phone #:
* Work #:
* Cell #:
* E-mail:
* Confirm E-mail:
How did you hear about Dominick?
Other: (please explain)

Delivery/Service Address

* Delivery Address:

Billing and Payment Information

* Billing Address: Same as delivery/service address

Only enter if you want invoices or other correspondence sent to an address other than the delivery/service address.




* Do you own or rent?

Own        Rent

Employment Information

Employer:
Years There:
Employer Address:

Service Plans

* I am interested in the following plans: (click all that apply.)

Heating Service Plans
Air Conditioning Service Plans
Oil Heat Maintenance Savings Plan
Air Conditioning Maintenance Savings Plan
ProGuard Tank Protection
None at this time

Delivery Information


* Types of Fuels Used at Home: (click all that apply.)

Oil      Propane      Natural Gas      Other

Home Information

Type of Heat System:(i.e. baseboard heat, hot air heat)


Do You Have AC Units?
Yes    No
If Yes, How Many Units Outside?

Number of Heating Zones:(how many thermostats in your home?)


When Was Last Tune-Up?
Age of Heating System?


Age of House?


* Estimated Size of Home
sq. ft.

Questions / Notes:

Previous Oil Company

Previous Oil Company Name:


* Are you currently enrolled
in a price protection contract?

Yes    No

If yes above, when does it expire?

Oil Terms and Conditions

  1. Delivery — We will deliver, subject to availability, fuel oil at our established price on the date of delivery unless another price has been established. Deliveries will be made to you at the address shown on this agreement, on an automatic basis according to Weather Controlled Degree Day System, unless our Credit Department has notified you that you must call for your oil. If your account is established as a will call delivery type, then we require 48 hours notice to arrange for a delivery.
  2. Payment — A metered ticket will be left or mailed to you after each delivery. The ticket will show the number of gallons delivered, the price per gallon and total dollars owed which is to be paid within 30 days. If other payment terms are required by our Credit Department, you will be notified by them through written notification or telephone.
    If you are on the BUDGET PLAN, payments are due by the 10th of each month.
    If you maintain a Service Contract with us, or if you require chargeable service calls for repairs or maintenance, these will be billed to your oil account and are to be paid within 30 days. Customer must pay a handling charge of $30 for any payment check or eft dishonored.
  3. Finance Charges — Charges of thirty (30) days or more are considered past due. We will send you a statement which will show the past due amount as well as your current month's purchases, and the FINANCE CHARGE. FINANCE CHARGES are computed at the rate listed below:
    1½% per month (equivalent to an ANNUAL PERCENTAGE RATE OF 18% PER ANUM).
  4. Default and Collection Costs — YOU will be in default if you do not pay a balance on time, file for bankruptcy, or make an assignment for the benefit of the creditors. Default means that we can demand immediate payment of the full balance. If we refer collection of the balance to a lawyer, you will pay all attorneys' fees plus court costs.
  5. Irregular Payment and Delay in Enforcement — We can accept later payments, or checks and money orders marked "payment in full" without losing any of our rights under this agreement. We can also delay in enforcing our rights under this agreement without losing them.
  6. Amendment or Changes — We can change this agreement including FINANCE CHARGES and the ANNUAL PERCENTAGE RATE at any time provided we give you at least 30 days notice before the beginning of the billing period in which the change becomes effective.
  7. Cancellation — We or you can cancel at any time on 30 days written notice. You agree to remain responsible for payment for all deliveries and/or services made before the 30 day period expires. We also have the right to cancel your account without notice if you fail to make payments on time.
  8. Liability — We are not responsible for damage or loss caused by failure to make delivery due to labor shortage, strikes, or to conditions beyond our control. In the event of DEFAULT, and we do not deliver oil as a result of DEFAULT, we will not be liable for any damages in either direct or indirect manner.
  9. If a price protection contract has been established then the terms and conditions of the price protection contract supercede these terms and conditions during the price protection period. Customer responsibilities will always apply.
  10. Dominick Fuel Inc. shall be released of liability for "runouts" when the customer's fuel usage is erratic and/or if oil tank fill pipe or vent are inaccessible or if vent alarm does not work.
  11. Per Service Plan terms & conditions, if you cease to be an automatic oil delivery customer or burn less than 600 gallons of fuel per annum we will rebill any past products or services performed during the contract year at our prevailing rates.
* I approve of the Credit Terms
  1. It is the customer's obligation to maintain modern, reliable heating equipment that is free of leaks and heavy corrosion, and to upgrade equipment as necessary so as to help prevent accidents and mitigate losses that may occur during fueling and regular use.
  2. Heating system must be protected from harsh elements including but not limited to water, snow and severe cold.
  3. Inspect system frequently for signs of corrosion, leakage, soot, unusual discoloration, and noises Dominick Fuel Inc. must be notified immediately of any defect or failure.
  4. Dominick Fuel Inc. shall be released of liability for loss of heat or any damage resulting from a freezeup in an occupied or unoccupied dwelling. It is the customer's responsibility to arrange for a daily house check if customer is away from the premises.
  5. The home's chimney must be maintained to ensure proper system operation.
  6. The homeowner should be proactive in protecting personal property, finished areas, dirt floors and sump pumps and controlling potential spills by secondary containment for oil tanks and oilburning equipment.
  7. Failure of the homeowner to take these preventive measures will release Dominick Fuel Inc. of any responsibility for any damages or losses suffered.
  8. Customer must provide safe and unimpeded access to the heating system.
  9. Dominick Fuel Inc. will attempt to deliver oil to you while parked on a public road. However, if your fill pipe is more than 30 feet from a public road, you must provide a suitable driveway for use by Dominick Fuel Inc. which is wide enough for, and can sustain the weight of, an oil truck. You must keep such driveway free of snow, ice, overhanging shrubs or trees, and other impediments. Dominick Fuel Inc. will not be held responsible for damages caused by the weight, width, or height of the oil truck.
  10. As our valued customer, we would like to make you aware of a potential problem that could occur with an unprotected fuel delivery line. These unprotected fuel delivery lines are made of copper and if in contact with concrete or below ground, may deteriorate, resulting in a line leak. In the event of such a leak, oil could be released, causing environmental damage that will require a costly cleanup. To avoid this exposure, both financially and personally, we suggest that you have your fuel delivery lines inspected and replaced with a sleeved line if necessary. Contact us to assist you with this upgrade.
  11. Per Service Plan terms & conditions, if you cease to be an automatic oil delivery customer or burn less than 600 gallons of fuel per annum we will rebill any past products or services performed during the contract year at our prevailing rates.
  12. Any and all special offers and promotions are based on annual usage of 800 gallons or more per year and on a twelve month automatic delivery commitment. If automatic delivery is canceled prior to the said 12 months all introductory offers will be null and void, and billed back to the account.
* I approve of the Customer Responsibilities

NOTICE

I hereby authorize you or any credit agency employed by you to investigate the references herein listed or any of the other information stated to determine my qualifications for a credit account.

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and answer questions about your credit experiences with me. I have read and agree to the credit terms and the customer responsibilities shown above.

By typing your name in the box below, you are "digitally" signing this document:
* Buyer's Digital Signature:

Social Security #: --

Date: 05/11/21