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New Customer
1
Personal Information
-- Select Primary Phone -- *
Cell Phone
Home Phone
Work Phone
2
Location Information
-- Select State -- *
MA
RI
-- Select Fill Location --*
1
2
3
4
5
6
7
8
3
Oil
Gallons *
Fill Up
50 ($25 charge)
75 ($25 charge)
100
125
150
175
200
225
250
300
350
400
450
500
600
700
800
900
1000
-- Select Tank Level --*
1/2 Full
1/4 Full
1/8 or less
Empty - I am able to restart
Empty - I need a restart - $45 convenience fee
275 (Standard Size)
330
550
660
Not Sure
Today's price: $3.19
Gallons: 150
Total: $478.5
4
Payment Information
-- Select Payment Option -- *
Pay Online
Money Order
-- Select Month --
01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
-- Select Year --*
2020
2021
2022
2023
2024
2025
2026
2027
2028
5
New Customer Information
-- Select House Option -- *
Single Family
Duplex - left side
Duplex - right side
Apartment - first floor
Apartment - second floor
Apartment - third floor
Other
-- Are You The Owner -- *
Yes - I am the owner
No - I rent
-- Select Best Way to Contact You -- *
Text
Cell Phone
Home Phone
Work Phone
Email
I would like additional information emailed to me about Automatic Delivery and/or the Triple Save Budget Program
Paperless Receipts
* I certify that my oil tank is in good working condition, it has not been altered, is piped correctly and it’s not leaking
For safety purposes, the insurance company requires pictures of your oil tank prior to the first delivery. Please add the specified pictures below. For examples of tank pictures, please
click here
.
Picture #1 Send a picture(s) of the oil tank *
Picture #2 Send a picture(s) of the oil tank (if necessary)
Picture #3 Send a picture(s) of the oil tank (if necessary)
Picture #4 Send a picture(s) of the oil tank (if necessary)
6
Additional Information
