Mercer Fuels - Automatic Delivery Sign Up

1

DateTime

2

Name* This field is required.

First Name

Last Name

3

Address* This field is required.

Street Address

City/Town

Postal / Zip Code

Country

4

Phone Number* This field is required.

Area Code

Phone Number

5

Email* This field is required.

example@example.com

6

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

Yes

No

I'm not sure

7

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

YESNO

8

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

Oil

Electric

I'm not sure

9

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

10

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

11

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

YESNO

14

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

15

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

16

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