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Current Residential Customer Order Request Form

If you are a current customer, you should use this form to place an order for fuel. If we have never delivered to you before, then please fill out the new customer form. Once you place the order, you will receive an auto-responder email to confirm that we received it.

If we have any questions about your order, we will contact you before bringing it out. Please remember...

This form makes the request for an order only.
We expect payment at time of delivery. (COD) We don't have accounts.
Payment are accepted by phone or by the driver upon delivery.
Online payments (coming soon)

If you have any questions or comments, use the comments field on the form

P.S. If you have any problems using the form or have questions, please contact us directly at 757-325-2373 or contact us here.

Current Residential Customer Order Form

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

Street Address*

City*

Zip/Postal Code*

Home Phone*

Business Phone

Fuel Type*

	Heating Oil
	Dyed Kerosene

How many gallons?*

Delivery Wanted (ex. today, Day of week)*

Form of Payment*

	Cash
	Check with drivers lic. number
	Credit card pay online or by phone

If you will not be home and paying by check where will it be?

Receipts are left behind the mailbox. Want a different location?

Additional Comments

I confirm that...*

	I am at least 18 years of age.
	I have read and accept the privacy policy.
	I understand that you will use my information to contact me or send me the information I requested.

Current Residential Customer Order Form

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

Street Address*

City*

Zip/Postal Code*

Home Phone*

Business Phone

Fuel Type*

	Heating Oil
	Dyed Kerosene

How many gallons?*

Delivery Wanted (ex. today, Day of week)*

Form of Payment*

	Cash
	Check with drivers lic. number
	Credit card pay online or by phone

If you will not be home and paying by check where will it be?

Receipts are left behind the mailbox. Want a different location?

Additional Comments

I confirm that...*

	I am at least 18 years of age.
	I have read and accept the privacy policy.
	I understand that you will use my information to contact me or send me the information I requested.

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Current Residential Customer Order Request Form

Current Residential Customer Order Form

Current Residential Customer Order Form

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