New Account Application

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New Account Applicationcoxfuelwp2019-10-01T19:28:04+00:00

Welcome!

We look forward to serving your heating needs. Please complete and submit the application below to establish your new account. Call 978-454-7887 if you have questions or encounter any problem with this form. Thank you.

Applicant's Name *

First

Last

Email *

Social Security # *

Co-Applicant's Name *

First

Last

Email *

Social Security # *

Home Phone *

Cell Phone *

Billing Address *

Address Line 1

City

State

Zip Code

How Long Have You Been At This Address? *

Own or Rent? *

Own
Rent

Delivery Address *

Address Line 1

City

State

Zip Code

Mortgage Bank / Landlord *

Address *

Address Line 1

City

State

Zip Code

Employment Information

Applicant's Employment *

Address *

Address Line 1

City

State

Zip Code

Employer's Phone *

Years With Company *

Position *

Applicant's Previous Employer if less than one year *

Address *

Address Line 1

City

State

Zip Code

Co-Applicant's Employment *

Address *

Address Line 1

City

State

Zip Code

Phone *

Years With Company *

Position *

Credit References

Bank *

Address *

Address Line 1

City

State

Zip Code

Phone *

Account Number *

Account Type (select one) *

Savings
Checking

Name On Credit Card *

Credit Card Number *

Emergency Contact

Name (person not living with you) *

Address *

Address Line 1

City

State

Zip Code

Phone *

Delivery Information

Fill Pipe Location (select one) *

Front of House
Back of House
Left Side of House
Right Side of House

Tank Size (select one) *

275 gallons
330 gallons
550 gallons
1000 gallons

Vent Alarm

Nearest Street

Delivery Instructions

Estimated Gallons in Tank (select one)

10-30 gallons
30-50 gallons
50-70 gallons
70-90 gallons
90+ gallons

Do You Have Budget Plan?

Type of Heat

Do You Have a Burner Service Plan?

Previous Provider *

Terms & Conditions

Click Here to Read Service Terms and Conditions

Please Tell Us How You Heard of Cox Fuel *

Friend/Neighbor
Newspaper/Magazine
Google Search
Bing Search
Social Media
Online Directory like Yahoo, Yelp

Winter Business Hours:
Monday thru Friday 8:00 am – 4:30 pm
Saturday 8:00 am. to Noon
Closed Sunday

Please contact office for all NON-EMERGENCY calls during business hours, e.g. pricing, billing etc.

24/7 EMERGENCY SERVICE

Schedule a Delivery

Our Customers Words…

“Just want to say ‘Thank You’ for making life a little easier and simple. You guys are great.”

– Joe Rao

CONTACT US

Heating Oil • Oil Burners
Boilers • Furnaces • Water Heaters
Complete Heating Systems

COX FUEL CO.
“The Comfort People”
316 Plain Street
Lowell, MA 01852

978-454-7887

Emergency Service: 978-454-7887
(monitored 24/7)