American Discount Oil Tank Inspection Form

Oil Tank Inspection Form

This form is intended for customers to submit photo's of there tank for a visual inspection. Once completed this form will be sent to our office to be reviewed.
First Name*
Last Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What color is the home or office where delivery will occur?*
Email*
example@example.com
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
What size is your tank(s)?*
How many tanks do you have?*
If you have multiple tanks are they connected together?*
What size is your tank(s)?*
If looking at the front of your house, where is your fill for your tank located?*
Is your tank at least 5 feet from any fire or flame?*
Would you like to be placed on automatic delivery?*
Please upload or use the "take photo" buttons below. You must provide photos of the top, bottom and copper lines on your tank.
Please upload a photo matching the one above of the top of your tank. All of the ports on the top of the tank must be tight.

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Please take a photo matching the one above of the top of your tank. All of the ports on the top of the tank must be tight.
Please upload a photo matching the one above of the bottom of your tank. (The bottom of the tank must be dry with no signs of wetness from oil. Oil patches or spots on the bottom of the tank are not acceptable. The tank may not be altered or repaired in any way from factory condition. This must be clear from the photo you provide.)

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Please take a photo matching the one above of the bottom of your tank. (The bottom of the tank must be dry with no signs of wetness from oil. Oil patches or spots on the bottom of the tank are not acceptable. The tank may not be altered or repaired in any way from factory condition. This must be clear from the photo you provide.)
Please upload a photo matching the one above of the copper lines going to your tank. (The supply line must be sleeved from the tank to the burner with a continuous non-metallic encasement. Bare copper lines are not up to code and need to be updated.) If you need to attach more than one clear photo of your line please do so.

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OR
Please take a photo matching the one above of the copper lines going to your tank. (The supply line must be sleeved from the tank to the burner with a continuous non-metallic encasement. Bare copper lines are not up to code and need to be updated.) If you need to attach more than one clear photo of your line please do so.
Please upload a photo of each of the 4 legs that hold up your tank. (All legs must be free of corrosion and able to support your tank.)

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Leg 1
Leg 2
Leg 3
Leg 4
Use this box to upload any more photos that you might need to to prove that your tank is in good condition.

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I certify that all the information provided below is accurate and the photo's provided are of the address that i provided above on this form. I further state that American Discount Oil Inc. will be held harmless and is in no way responsible or liable for said equipment and/or its use. In addition, I understand that Pioneer Valley Oil Inc. may at any time suspend, discontinue and /or terminate supply service to said equipment for any reason Pioneer Valley Oil Inc. deems proper.*

I Agree
Please verify that you are human*
Should be Empty: