Form

REQUEST HOME DELIVERY OF FUEL OIL, KEROSENE, OR PROPANE

This form is to request delivery of heating oil, kerosene or propane for our current residential customers.If you would like to start an account with us, please call 1-800-672-6604 or 336-722-3441 or email our Fuel Oil Manager.Please note: Our hours of operation are Monday-Friday from 8:00 am to 5:00 pm. Requests after normal operating hours will be handled the next business day. For emergency after hours delivery, please call 336-722-3441. After we have received your request, we will contact you to confirm delivery.If we have not contacted you within 24 hours, please call our office at 800-672-6604 or 336-722-3441.To avoid duplicate orders, please do not call to place an order if you have already submitted a request online. Thank you.
Please Choose One: *

New Customer Existing Customer
Name on Account *

First Name Last Name
Your name, if different

First Name Last Name
Account number, if known
Email address *

Physical Address *

Mailing address, if different

At least one phone number is required
Work Phone

- Area Code Phone Number
Home Phone

- Area Code Phone Number
Cell Phone

- Area Code Phone Number
Request Type (choose one) *

Heating Oil Propane Kerosene
I am interested in the following programs

Keep Fill Customer Advantage Plan Easy Pay Automatic Draft
Percent in propane tank now (found on gauge under dome - propane only)
Amount requested - Next Day Delivery:100-Gal. Minimum or (Same Day Delivery: 150-Gal. minimum) *
Special Requests: anything we should be aware of?
Account changes or updates (e.g. new phone number, new address)
On the final step: You will be required to enter a digital signature which will be binding as your
actual signature. Your electronic signature below indicates your agreement with the following statements:

By typing my name in the following box I certify the above statements to be true and correct,
to the best of my knowledge, and that this information can be used for the purpose of processing
my request for home delivery.
Type your name here *
Enter the text shown in the image *
Should be Empty:

REQUEST HOME DELIVERY OF FUEL OIL, KEROSENE, OR PROPANE