My Maritime

Become a Customer

ACCOUNT HOLDER'S DETAILS

Name(Required)

First Last

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Primary/Home Phone(Required)

Cell Phone

Work Phone Phone

Email(Required)

Electronic Communications Enrollment

e-Statements

e-Invoices

Delivery/Service Reminders

Are you an Existing Maritime Customer or have you ever been a customer of Maritime Energy?(Required)

No - I am a new customer

Yes - I am an existing customer adding another location

Yes - I am a former customer looking to return

Account # - Existing Customer Only

It's OK if you don't know it, we will still be able to find your account with the information provided in this form.

Do you rent or own this location?(Required)

Own

Rent

Landlord's Full Name & Phone Number

Would you like to add an Authorized Contact on this account?(Required)

Yes - Add an Authorized User

No - Only me on the account

This person listed on this form will have access to your account information, as well as be able to make delivery and/or service requests which may result in charges.

Authorized Contact's Name

First Last

Authorized Contact's Phone #

Authorized Contact's Email

DELIVERY LOCATION DETAILS

Untitled

Same As Billing Address

Delivery Address(Required)

Street Address Address Line 2 City State ZIP Code

Delivery Instructions(i.e. House Color/Style, Landmarks, Gated, Access Rules, etc.)(Required)

Previous Fuel Provider

Other Fuel Provider - Please Specify

FUEL TYPE

Check all that apply

Oil #2

Propane

Off Road Diesel

Fuel Tank Size(Required)

138 Gallons

275 Gallons

330 Gallons

Unknown/Other

Fuel Pipe/Tank Location

Fuel Gauge Level(Required)

Fuel Auto-Delivery(Required)

Yes

Credit Approval Required for automatic deliveries - If YES is selected, the credit application will be displayed further down in this form

Heating System(Required)

Boiler

Furnance

K-1

Monitor

Other

Hot Water Source(Required)

Oil

Propane

Electric

Other

Propane Tank Size(Required)

120

240

Other

Unknown

Is this a Maritime Energy tank?(Required)

Yes

Propane Tank % Level(Required)

Propane Auto Delivery?(Required)

Yes

Credit approval required for automatic deliveries - If YES is selected, the credit application will be displayed further down in this form

Propane used for

Boiler

Furnace

Hot Water

Generator

Fireplace

Gas Stove / Cooking

Gas Dryer

Space Heater

Pool

ADDTIONAL OPTIONS & SERVICES

I am interested in (Check all that apply)

Automatic Payments - Credit Card or EFT (EFT for Budget Plan Only)

Credit Application for Automatic Delivery and/or General Line of Credit

Generator Fuel Hookup

Heat Pump Quote/Installation

Inspection Appointment

Price Protection Plan - Budget CAP, Preferred CAP, Fixed Price

Service Plan Contract

Tune Up for Heating System

CREDIT APPLICATION (RESIDENTIAL ONLY)

Rev. 2023-04-19 - Information submitted in this section is encrypted for secure storage and transmission.

Prior to submitting this application, if you have frozen your credit, please have the freeze removed. Maritime Energy is unable to process your application if your credit is in a frozen state. Maritime Energy exclusively uses TransUnion as their consumer credit reporting agency; please allow TransUnion to access your credit data. For more information about freezing and unfreezing your credit, please visit: https://www.transunion.com/credit-freeze

Credit is Unfrozen and can be checked(Required)

Yes

Credit Applicant's Full Legal Name

First Middle Last Suffix

Date of Birth(Required)

Social Security Number(Required)

Phone Number(Required)

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Current Employer

Length of Employment

Employer's Phone Number

Applicant's Signature(Required)

Co-Applicant?(Required)

Yes

Co-Applicant

Co-Applicant's Full Legal Name(Required)

First Middle Last Suffix

Date(Required)

Phone Number

Social Security Number(Required)

Co-Applicant's Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Current Employer

Length of Employment

Employer Phone Number

Co-Applicant's Signature(Required)

SUBMISSION & CONSENT

Account Holder's Signature(Required)

CAPTCHA