Credit Request

If you are interested in applying for a 30-day billing account, a budget account or an automatic fuel delivery account, please fill out the form below. A standard credit check will be run and you will receive an immediate response on your screen. If you have any questions, please call our credit department at 804-730-5000.

Date

Name

Date of Birth

XX 01 02 03 04 05 06 07 08 09 10 11 12

XX 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

XXXX 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

Current Address

St Rd Ct Dr Ln Pl Vw Ave Cir Hwy Mnr Ter Tpk Trl Way Blvd Loop

Phone Number

Woodfin Account Number

Need New Account Setup?

Yes

No

If yes, what type of service would you like to include: (choose as many as you would like)

Heating/Cooling

Plumbing

Electrical/Generator

Indoor Air Quality

Propane

Heating Oil

Email Address

I would like to have my credit run to setup for

30-Day Billing Account (fuel customers only)

Budget Account (fuel customers only)

Automatic Delivery (fuel customers only)

Signature of Acknowledgment

Clear

I understand that by filling out this form, I am agreeing to have Woodfin - Your Home Team run a standard credit check.