Residential Fuel ORDER FORM
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Account Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a HEAP recipient?
*
Yes
No
Product
*
Please Select
Propane
Kerosene
Fuel/Heating Oil
Fuel/Heating Oil - All Weather
Tank Level
*
Please Select
50%-40%
40%-30%
30%-20%
20%-10%
10% or less
1/8
1/4
1/2
3/4
Empty (Extra Fees May Apply)
Unknown
Fill Type
*
Please Select
Fill
Number of Gallons
Number of Gallons Requested
Please note our minimum deliver is 150 gallons.
Delivery Instructions:
Submit
*Important notice: All orders may take up to 72 business hours to be delivered. Customers needing an immediate delivery, please call the office for assistance. 1-800-662-6776. Thank you for your Business.
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