BECOME A CUSTOMER

BECOME A CUSTOMER
APPLICANT CONTACT INFORMATION*

First NameMiddle NameLast NameSuffix
CO-APPLICANT CONTACT INFORMATION

First NameMiddle NameLast NameSuffix
BILLING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo (please add below)
DELIVERY ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CELL PHONE NUMBER

Area CodePhone Number
HOME PHONE NUMBER*

Area CodePhone Number
EMAIL*
example@example.com
OWNRENTLANDLORD
HEAT ONLYHEAT & HOT WATERUNSURE
HEATPUMPGAS FIREPLACEWOOD STOVENO OTHER HEAT SOURCE
DELIVERY INFORMATION

If you would like to include more detailed information, please use the fields below. (This is NOT required but will help us provide a more comprehensive follow up with you.)
AUTOMATICWILL CALL
275 GALLONS (STANDARD)OTHER SIZENOT SURE
Less than 1/41/41/23/4Full
FILL SPOUT LOCATION & DELIVERY INSTRUCTIONS
YESNO
LAST TWO (2) DATES OF DELIVERIES AND GALLON AMOUNTS DELIVERED - Complete this section ONLY if you are signing up for Automatic Delivery
SERVICE CONTRACTS
YESNO
Thank you very much for reaching out to Chester County Fuel. We will email you a New Customer Information Packet within two business days.

If you are in need of oil or service immediately, please call the office at 610-344-7234. If after hours, please follow the phone prompts and someone will get back to you as soon as possible.
ANY ADDITIONAL DETAILS YOU WOULD LIKE US TO KNOW?
Applicant's Electronic Signature (Type Name)*
Co-Applicant's Electronic Signature (Type Name)
Should be Empty:

BECOME A CUSTOMER

DELIVERY INFORMATION

SERVICE CONTRACTS