Credit Application Please fill out this form and click the Send button below. Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail* License NumberDate of Birth Date Format: MM slash DD slash YYYY Are you a homeowner?YesNoDelivery address if not the same as aboveAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code I certify that my oil tank and piping are free of leaks and functioning properly Please choose automatic or will call deliveryAutomaticWill CallWould you like a budget plan?YesNo, thank youGallons used per yearSelect your payment method*Cash/CheckCredit Card*To be kept on file choose a credit card or a credit deposit of $500.00 (not required for budget plans). How did you hear about us?FriendNewspaperSaw Your TruckOnline SearchPlease choose the number closest to your fill pipe*T1T2T3T4T5T6T7T8Please put your initials in the box as your e-signature** I have read and agree to the terms and conditions and that the initials in the box above will serve as my electronic signature. CAPTCHA HomeOrder Oil Now Frequently Asked QuestionsCustomer Signup Links and Fuel AssistanceContact Us
