*Full Name:

*Email

Customer #:

(If you are REPEAT CUSTOMER, please fill the above field)

*Phone:

  Desired date of delivery:

We will do our best to make the delivery on the date you requested. However, it may take up to 3 business days for us to complete your delivery. If you are in danger or running out of oil, please call our office at (203) 250-1030 as soon as possible.

  Number of gallons requested:

Fill Tank

Gallons:

  How will you be paying for this delivery?:

Leave cash or check on the fill pipe

Leave cash or check in the door

Credit card over the phone. 
(Visa or MasterCard only)

  Special Instructions for this delivery only: