Tank Warranty Form

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What Type of Tank do you have?*

Tank Size in Gallons*

Is the Tank easily accessible?*

If not, please describe what would need to be removed to gain access to the tank?

Where is the tank located?*

Is the tank in service?*

How long has the tank been in service?*

Has this tank ever been tested?*

Do you have reason to believe this tank is leaking?*

If yes, indicate specifics

Are there any warrantees or coverage’s of any type on this tank?*

If yes, indicate specifics

Are you on well water or public water?*

Homeowners Insurance company?*

How long have you been covered?*

Prior Homeowners Insurance Comapny?*

Dates they were covered?*

Secondary Insurance Company?*

How long in home ?*

Fuel Oil Dealer?*

Are you on automatic delivery?*

Fuel oil company service contract on tank?*

Additional Infomation

At the time of submitting this Application, I am not aware of any current or prior emission, discharge, or release of fuel oil from my fuel oil system. I understand that knowingly providing false or inaccurate information will be cause for disqualification and/or termination from the Tank Warranty Program.