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Request Delivery of Heating Oil, Kerosene or Propane

Return to Propane
Return to Home Oil/Kerosene Delivery & Service

This form is to request delivery of heating oil or propane for our current customers.
If you would like to start an account with us please call 336-722-3441.

Please provide the following contact information:

Name on Account
Your Name (if different)
Acouunt Number (if known)
Physical Address
City
State
Zip code
Mailing Address (if different)
City
State
Zip code
Work Phone
Home Phone
Cell Phone
Pager
E-mail
Request Type Heating Oil   Propane   Kerosene
Percent in propane tank now
(found on gauge under dome)		 %
Special Request
(anything we should be aware of)
Account Changes
(eg address/phone changes)


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