Order Oil Online

Oil Delivery Request
Name:		Telephone Number:
Delivery Address (Apt#/Flr#):		Cell/Business Number:
City:		State:	Zip:
Business/Billing Address:		State:	Zip:
City:		Email:
Do you own or rent?
I would like to setup an Automatic Delivery Account using my credit card
Or I will call or e-mail for all deliveries using my credit card
Name of Last Fuel Supplier:		City:
Do you want a cancellation letter sent to this supplier?
Payment Information
I would like to set up an automatic delivery account using my credit card. Select Card:
Account Number: Existing customers may enter their account number here.			Expiration Date:
Name as it appears on card:
If you prefer, leave this section blank and call us (Fireman's Fuel 1-877-662-0045) with your credit card information.
Delivery Information
Tank size in gallons (standard is 275):		Hot water source:
IF YOU ARE STANDING IN THE STREET LOOKING AT YOUR FRONT DOOR - MUST BE SPECIFIC LOCATION (if the office has questions, we will call you) Location of fill pipe:
You may also print this form from your browser and mail or fax it to us.
Mail to:	Fireman's Fuel P.O. Box 761036 Melrose, MA 02176	Fax to:	781-224-4178