New Customer Form in Eastern NC

We appreciate your interest in Tidewater Energy. There are several ways to begin a relationship with us. You can always call your nearest location. For your convenience, we have also included a credit application form below for you to fill out. The information will be sent directly to our credit department for review. This is the quickest way for us to process your request.

We also understand that some people are not comfortable with this procedure. Therefore, you may download a copy of our credit application below and fax it to Tammie Howard at 252-523-8191 or e-mail her at t.howard@lharveys.com.

Download PDF

Credit Application:

Energy Use
Do You Currently Use Propane*
- Yes
- No
How Do You Use (or plan to use) Propane?*
Applicant Demographic Information
Name*
First Middle Last Suffix
SS#*
Date Of Birth*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Own or Rent?*
Monthly Payment/Rent*
Years Lived Here?*
Previous Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
How Long At Previous Address
Months/Years
Primary Phone*
Alternate Phone
Email
Employment Information
Name Of Employer*
If not Employed Type "Not Employed".
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Your Current Position*
How Long Employed?
Work Phone
Salary*
Frequency*
Reference Information
Name of Nearest Relative Not Living with You*
First Last
Address of Nearest Relative Not Living with You*
Street Address City State / Province / Region ZIP / Postal Code
Phone of Nearest Relative Not Living with You*
Is There A Co-Applicant?
- Yes
Co-Applicant Demographic Information
Co-Applicant Name*
First Middle Last Suffix
Co-Applicant SS#*
Co-Applicant Date Of Birth*
Co-Applicant Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Co-Applicant Own or Rent?*
Co-Applicant Monthly Payment/Rent*
Co-Applicant - Years Lived Here?*
Co-Applicant Previous Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Co-Applicant - How Long At Previous Address
Months/Years
Co-Applicant Primary Phone*
Co-Applicant Alternate Phone
Co-Applicant Email
Co-Applicant Employment Information
Co-Applicant Name Of Employer*
If not Employed Type "Not Employed".
Co-Applicant Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Co-Applicant Current Position*
Co-Applicant - How Long Employed?
Co-Applicant Work Phone
Co-Applicant Salary*
Co-Applicant Pay Frequency*
Co-Applicant Reference Information
Name of Nearest Relative Not Living with Co-Applicant*
First Last
Address of Nearest Relative Not Living with Co-Applicant*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone of Nearest Relative Not Living with Co-Applicant*
Terms & Conditions
Terms & Conditions*
Please agree to our terms & conditions.
- I have read and agree

By submitting this form you authorize Harvey Fertilizer and Gas Company, DBA Tidewater Energy to pull your credit report for the purpose of determining eligibility for an account with Tidewater Energy. A separate “service agreement” will need to be completed by both Tidewater Energy and the customer after credit has been approved.

New Customer Application

New Customer Form in Eastern NC

Credit Application:

Energy Use

Applicant Demographic Information

Employment Information

Reference Information

Co-Applicant Demographic Information

Co-Applicant Employment Information

Co-Applicant Reference Information

Terms & Conditions