Mercer Fuels - Automatic Delivery Sign Up

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DateTime

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Name* This field is required.

First Name

Last Name

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Address* This field is required.

Street Address

City/Town

Postal / Zip Code

Country

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Phone Number* This field is required.

Area Code

Phone Number

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Email* This field is required.

example@example.com

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Are you interested in automatic fuel delivery?* This field is required.

Yes

No

I'm not sure

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Are you already a Mercer Fuels customer?* This field is required.

YESNO

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Is your hot water heater oil or electric?* This field is required.

Oil

Electric

I'm not sure

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How many people live in the house?* This field is required.This helps us calculate how much oil you will use for hot water

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Once your account is set up, what will be your preferred method of payment?* This field is required.

Credit Card on File

Automatic Debit Withdrawals

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Are you interested in setting up an equal monthly payment budget plan? * This field is required.

YESNO

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Please verify that you are human* This field is required.

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By clicking Submit, you agree to Mercer Fuels' terms of use and privacy policy.

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