Forms

Here are some important forms you will need:

Service Application

Please fill out the required information below to submit a Service Application:

(Click here for a printable version.)

* = required
Applicant Name *
Social Security/Federal Tax I.D. # *
Physical Address *
City *
State *
Zip Code *
Billing Address *
City *
State *
Zip Code *
Phone Numbers:
Home *
Work
Mobile
For Joint Accounts:
Spouse Name
Social Security #
How property being served (select one):*

If rented:
Landlord's Name
Landlord's Phone
 
Directions To Property:*
County *
Type of Service
(example: Propane
Gas)		 *

Automatic Delivery (select one): *

List of all appliances being used (example: central heat, water heat, etc.): *

The above named person or entity (the "Applicant") hereby applies for credit from K.B. Johnson Oil & Gas Company. In connection therewith, Applicant provides the information set herein. The information provided will be utilized by K.B. Johnson Oil & Gas Company for the purpose of processing this application and inquiring into the Applicant, and such information will be kept confidential except in connection with the said purposes.

The undersigned hereby certifies that all of the information provided in this application for credit is true and correct. Furthermore, the credit and collection terms of K.B. Johnson Oil & Gas Company as explained to the undersigned and agreed to, and prompt payment of any indebtedness owned to K.B. Johnson Oil & Gas Company is hereby guaranteed. "Applicant" hereby agrees to pay any legal/collection/court costs associated with this indebtedness.

I agree to these terms


 


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K.B. Johnson Oil & Gas Co. - 1709 North Main Street, Fuquay Varina, NC 27526 - Phone: 919-552-5474
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