Printable Customer Application

New Customer Application

Mail to:
Bennington Cooling & Heating
303 Depot St
Bennington, VT 05201

Residential Customer Form

Residential Application

First Name*

Last Name*

Email*

Phone*

Service Phone (if different)

Billing Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Service Address (if different)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Tell us about your project*

Signature*

Terms are net 10 days with 2% interest on accounts

If this account is placed in the hands of a bonded collection agency, or an attorney for collection, the undersigned shall pay all fees incurred as a collection fee, which the undersigned agrees is reasonable.

This is to certify that I am a principal in the above business and in consideration for the extension of credit by Bennington Cooling and Heating, I do hereby personally guarantee payment of any and all invoices which remain unpaid.

Commercial Customer Form

Commercial Application

Business Name*

Contact Name*

Email*

Business Phone*

Service Phone (if different)

Billing Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Service Address (if different)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Tell us about your project*

First Principal or Officer Name

First Principal or Officer Title

Second Principal or Officer Name

Second Principal or Officer Title

Third Principal or Officer Name

Third Principal or Officer Title

Trade Reference 1 (Name, Address, Phone)

Trade Reference 2 (Name, Address, Phone)

Trade Reference 3 (Name, Address, Phone)

Signature*

Your Title

Terms are net 10 days with 2% interest on accounts

Printable Customer Application

Residential Customer Form

Commercial Customer Form

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