All fields marked with an asterisk (*) are required.
Customer Information
Property
*
Main residence
Rental property
Seasonal property
Name
*
Date of Birth
*
Mailing Address:
*
City/Town
*
State
*
Zip
*
Home Phone
Cell Phone
*
Current Employer
*
Work Number
*
E-mail
I grant permission to use the above information for credit inquiry purposes.
*
Yes
No (Contact me)
If Renting
Landlord's name
Address
Delivery Address (if different):
City/Town
State
Zip
Phone
Product and Delivery information
What type of fuel(s) do you need?
*
#2 heating fuel
Kerosene
Propane
For Propane only: who is your current supplier?
The hot water is heated by:
*
Oil
Propane
Electricity
Can we use your driveway to make a delivery?
*
Yes
No
Facing your driveway, your fill pipe is located:
*
Front
Driveway side
Back
Far side
Other
What is the gauge reading:
*
Annual usage:
Tank size:
*
Once completed, this application will be processed on the next business day. If this is an emergency, call the office directly at 1-800-649-6457. When the Credit Department has processed your application, you will be contacted by the office to schedule a free inspection of your oil storage tank before a delivery is scheduled.