Domestic Customer AgreementDomestic Customer Agreement • July 4th, 2018
Contract Type FiledJuly 4th, 2018Applicant Details Joint Applicant Details Title Mr/Mrs/Miss/Other: Title Mr/Mrs/Miss/Other: Surname: Surname: Forenames: Forenames: Date of Birth: Date of Birth: Contact Details Home: Mobile: Home: Mobile: Email: Email: Address: Time at address: Post code: Billing address (if different from above): Post code: Previous address (If less than 3 years at current property): Post code: Property Details Owner: YES / NO Tenant: YES / NO Date Purchased: Date tenancy commenced: Tank Size: Tank Location: Other Special Instructions: Please send me the following information (tick applicable):Full Info Pack Direct Debit Boiler Maintenance Auto Delivery Ebilling: YES / NO Preferred Comunication: Tel / email / Letter Agreement I/We apply for a domestic customer account with Manx Petroleums Ltd. Date: Signature: Signature: