Discount Propane Prices

Residential

Commercial

Last Name:

First Name:

Delivery Address:

Located Between:

City:

State:

Zip:

Special Instructions:

Billing Address:

Same as delivery address

City:

State:

Zip:

Home phone:

Work phone:

E-mail:

Former oil supplier:

Date of last delivery:

/

Do you have a dog in yard?

Yes

No

Do we need a key for gate or door?

Yes

No

Tank size:

If other tank size please specify:

Approximate oil consumed per year:

Type of delivery:

Automatic

Will-call

Do you have an underground oil tank?

Yes

No

Do you heat your water with oil?

Yes

No

Where is your oil fill?

Back of House

Left side

Right side

Front of House

Do you have a separate oil-fired hot water heater?

Yes

No

Payment type:

Cash

Check

Credit Card

Card type:

Visa

MC

Discover

AMEX

Credit Card # (last 4 digits):

EXP. Date:

/

Automatic Credit Card Deduction on all deliveries:

Yes

No

Charge my Credit Card one time (1x):

Yes

No

Your name:

I authorize Pilgrim Oil Group suppliers to deliver my fuel and check my credit.

New Customer Registration - HEATING OIL