CUSTOMER INFORMATION

NAME
ADDRESS
CITY/ST./ZIP
HOME PHONE
CELL PHONE
WORK PHONE
EMAIL ADDRESS
OWN OR RENT?
DID SOMEONE REFER YOU?
IF "YES" WHO?

DELIVERY INFORMATION

DELIVERY ADDRESS
CITY/ST./ZIP
DELIVERY INSTRUCTIONS
FUEL TANK SIZE
PROPANE TANK SIZE
LOCATION
PRODUCT/SYSTEM
FILL LOCATIONS
(SEE CHART TO THE RIGHT)
FILL PREFERENCE W/C @30% or ALLOW 3-4DAYS FOR DELIVERY
REQUIRED.INFORMED OF RUN OUT CHARGES.
*(INCASE OF DELIVERY HOLD OR WILL CALL CUSTOMERS)
DURING BUSINESS HOURS:
$50.00 LEAK TEST CHARGE
$50.00 OUT OF ROUTE CHARGE
 AFTER BUSINESS HOURS:
$100.00 LEAK TEST CHARGE
$100.00 OUT OF ROUTE CHARGE

PROPANE USE
APPROX. GALLONS IN TANK
YEARLY GALLONS
ADDITIONAL HEAT SOURCE
HEAT PUMP
KEROSENE HEATER WOOD STOVE

SERVICE INFORMATION

SERVICE AGREEMENT
BUDGET PLAN
HEATER
HWG
DELIVERY NEEDED ASAP
ACCEPTED

REQUIRED. BY CHECKING THIS BOX YOU AGREE TO THE FOLLOWING:

  RETAIL AGREEMENT (CLICK TO OPEN)
 
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© 1919-2010 Allens Oil Company - All Rights Reserved

Vincentown Office | 427 N. Main Street | Vincentown, NJ 08088 | Phone:  609-859-2334 | Fax: 609-859-1876
Hammonton Office | 849 S. White Horse Pike | Hammonton, NJ 08037 | Phone: 609-561-7714 | Fax: 609-859-1876

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