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. Someone will contact you shortly after receiving the application for additional information.

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.

Credit Application:

*
 
 
How do you use (or plan to use) propane?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
*
 
First Name:
 
 
 
Middle Name:
 
 
 
Last Name:
 
 
 
Date of Birth:
 
 
 
 
Social Security #:
 
 
 
Address:
 
 
 
City:
 
 
 
 
Zip:
 
 
 
Daytime Phone:
 
 
 
Cell Phone:
 
 
 
Your Email:
 
 
 
 
Current Employer:
 
 
 
Years with current employer:
 
 
 
 
 
 
Relative/Reference:
 
 
 
Relative/Reference Phone:
 
 
 
Relative/Reference Address:
 
 
 
 
 
 
 
Requested My Account username:
 
* Username must be 3-20 characters
 
 
Requested My Account password:
 
* Password must be 3-20 characters
 
 
 
 
 
 
 
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.
Call us today at (252) 523-9090