Credit Application Please fill out this form and click the Send button below. Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail* License NumberDate of Birth MM slash DD slash YYYY Are you a homeowner? Yes No Delivery 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 delivery Automatic Will Call Would you like a budget plan? Yes No, thank you Gallons used per yearSelect your payment method* Cash/Check Credit 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* T1 T2 T3 T4 T5 T6 T7 T8 Please 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 Δ HomeOrder Oil Now Frequently Asked QuestionsCustomer Signup Links and Fuel AssistanceContact Us
