Residential Credit Application

Rev. 2023-04-19

"*" indicates required fields

IMPORTANT INFORMATION BEFORE YOU BEGIN YOUR APPLICATION

This Credit Application is for existing customers only. If you are a new customer interested in our services, please fill out the Become A Customer form instead. 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*

Yes

CREDIT APPLICATION

Account Number

If you don't know your account number, it's ok to leave this blank -- we'll still be able to find your account.

Hidden

New Customer or Existing Customer?

I request a Credit Application for the following services*

Automatic Delivery - LP

Automatic Delivery - Oil

General Use - Line of Credit

Appliance Purchases

Check all that apply

Applicant Name*

First Middle Last Suffix

Date of Birth*

Social Security Number*

Phone Number*

Current Address*

Mailing/Resident Address City State / Province / Region ZIP / Postal Code Country

Current Employer

Full Business Name

Length of Employment

Employer Phone Number

Applicant Signature*

Co-Applicant?*

Yes

Co-Applicant

Co-Applicant Name*

First Middle Last Suffix

Date of Birth*

Co-Applicant DoB

Social Security Number*

Contact Phone Number

Current Address*

Mailing/Resident Address City/Town State / Province / Region ZIP / Postal Code Country

Current Employer

Full Business Name

Length of Employment

Employer Phone Number

Co-Applicant Signature*

Privacy Policy & Submission Consent

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