Become a CFE Customer (Residential)
  1. Want to join the 36,000 plus satisfied customers of Crystal Flash Energy? To expedite the application process, please complete the following one application, or contact your local office. (Please note: New Customer pricing applies to anyone who has not purchased from CFE in the last three years.)
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  3. All fields that have an asterisk (*) must be answered.
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  5. What Fuel Products Are You Interested In?
  6. Check All That Apply(*)
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  7. If Other - Describe
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  9. PERSONAL INFORMATOIN
  10. First Name(*)
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  11. Last Name(*)
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  12. Suffix
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  13. Last 4-digits of your social security #(*)
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  14. Billing Street Number(*)
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  15. Billing Street Direction
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  16. Billing Street Name(*)
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  17. Billing Address #2
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  18. Billing City & State(*)
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  19. Billing Postal Code(*)
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  20. Billing County(*)
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  21. Billing Township(*)
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  22. Renting or Buying?(*)
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  23. Name of Landlord (if renting)
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  24. Landlord's Phone Number
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  25. Time of Residence (years)(*)
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  26. Time of Residence (months)(*)
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  27. (If time of residence is less than a year)
  28. Previous Address
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  29. Previous City & State
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  30. Previous Postal Code
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  31. Date of Birth (format mm-dd-yyyy)(*)
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  32. Home Phone Number
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  33. Cell Phone Number
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  35. EMPLOYMENT INFORMATION
  36. Employer
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  37. Work Phone Number
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  38. Length of Employment
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  39. Previous Employer (if less than 1 yr)
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  41. DELIVERY INFORMATION - Enter Delivery Address information, only if different than Billing Address
  42. Delivery Address
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  43. Delivery Address #2
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  44. Delivery City & State
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  45. Delivery Postal Code
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  47. CO-APPLICANT INFORMATION - Enter Co-Application information, only if a joint application is requested.
  48. Co-Application First Name
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  49. Co-Applicant Last Name
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  50. Co-Applicant Suffix
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  51. Co-Applicant Last 4-digits of SS#
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  52. Co-Applicant's Date of Birth (format mm-dd-yyyy)
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  53. .
  54. Co-Applicant's Employer
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  55. Co-Applicants Employer Phone #
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  56. Co-Applicants Length of Employment
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  57. Previous Employer (if less than 1 yr)
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  58. .
  59. SERVICE REQUEST INFORMATION
  60. Size of Tank
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  61. Delivery Account Type(*)
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  62. Additional Delivery Type Information
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  63. Credit Rating
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  64. Estimated Annual Gallons (for budget only)
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  65. First Service Date Requested (format mm-dd-yyyy)
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  66. .
  67. Check here if you would like to go green
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  68. Customer Email Address
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  69. .
  70. AGREEMENT - I hereby certify that the information provided is true and accurate and that I am authorized to bind the applicant to the terms of this Credit Application, and the terms of subsequent purchases of products/services from Crystal Flash Energy. Crystal Flash Energy is hereby authorized to contact any of the references I have listed and conduct credit checks by way of a credit report of the applicant as it deems necessary. In the event, the applicant fails to pay any amount due Crystal Flash Energy under the terms of this account, applicant agrees that, in addition to the amount due on the account, Crystal Flash Energy shall be entitled to recover the maximum allowable rate of interest on the amounts due, together with costs of collection, including attorney's fees.
  71. Check to Agree
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  72. .
  73. ADDITIONAL QUESTIONS
  74. How did you hear about CFE?(*)
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  75. Referred by a friend, customer, or employee? Enter Name Here...
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  76. .
  77. What was the primary reason you have selected CFE as your supplier?
  78. Primary Reason?(*)
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  79. Other
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  81. Enter email to receive copy of form(*)
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  83. Anti-Spam Protection. Enter the characters you see