AUTO Primary Name on Account *

First Name

Last Name

AUTO Primary Phone *

(###)

###

####

Secondary Phone *

(###)

###

####

Delivery Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

If different from delivery address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is this service address a business? *

YES

NO

Would you like a delivery every 3 weeks due to your higher usage? *

Yes

No

Not applicable

Product *

Regular ULS Home Heating oil (inside tanks)

Kerosene (outside tanks)

50/50 blend

Tank Size *

In gallons

275 (common)

220

500

1000

2000

Other

Do you have an additional heat source that is used regularly? *

No

Yes - Wood / Pellet / Electric

Do you use oil for hot water? *

Yes

No

Do you live in the home year round? *

Yes

No

Payment Method type *

Call the office to put your credit card/banking information on file. For security purposes we ask that you do not transmit this information by email.

Credit card

Electronic Check (ACH)