STATE OF MAINE DEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATION

state of maine department of professional & financial regulation 35 state house station augusta, me 04333 tel: (207)624-8500

STATE OF MAINE
DEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATION
35 STATE HOUSE STATION
AUGUSTA, ME 04333
TEL: (207)624-8500 FAX: (207)624-8690
HEARING IMPAIRED: 1-888-577-6690
Location: 76 Northern Avenue, Gardiner, Maine
Office Use Only
Check #: _______________
Amount: _______________
Cash #: ________________
2025-1421
INTENT TO OFFER HOME HEATING OIL, KEROSENE OR
LIQUEFIED PETROLEUM GAS PREPAID CONTRACTS
10 MRS §1110(1-A)
REGISTRATION FEE: $100.00
(Nonrefundable)
Make Check Payable to: Maine State Treasurer
A home heating oil, kerosene or liquefied petroleum gas dealer who
offers prepaid contracts shall register the dealer’s intent to offer
such contracts by June 30th of each year. The dealer shall also file
an annual report by October 31st demonstrating how the prepaid
contracts are secured.
DEALER INFORMATION (PLEASE PRINT)
Name
Mailing Address
City
State
Zip Code
Telephone
Fax
County
Email
By my signature, I hereby certify that I/we intend to offer home
heating oil, kerosene or liquefied petroleum gas prepaid contracts. I
understand that I/we will need to file an annual report with the
Commissioner of Professional and Financial Regulation by October 31st
of this year demonstrating how the prepaid contracts are secured.
________________________________________
Signature of Dealer or Corporate Officer of Dealer
____________________________________________
Printed Name
_____________________________
Date
___________________________
Corporate Office Held (if applicable)