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If instead of filling the online form, you want to print the form and mail it to us - please, click here to download the MS Word file.

PILGRIM OIL GROUP
TEL: 1-800-774-0062
FAX: 1-888-267-3897
For authorized use only

NEW CUSTOMER REGISTRATION - HEATING OIL

Residential
Commercial
  Last Name:   First Name:
  Delivery Address:   Located Between:
 City:   State:   Zip: SPECIAL INSTRUCTIONS
 Billing Address:   Same as delivery address
 City:   State:   Zip:
 Telephone: Home:   Work:
 E-mail Address:
  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
  Fuel tank size 275 550 1080   Other:   Approximate oil consumed per year:
 Type of delivery: Automatic Will-call
 Do you have an underground oil tank? Yes No
Where is your oil fill?
Back of House

Left
side
House Upper View
Right
side
Front of House
 Do you heat your water with oil? Yes No
 Do you have a separate oil-fired hot water heater? Yes No
  Payment type:  Cash  Check  Credit Card

  Credit Card # (last 4 digits):   EXP. Date: /     Visa MC Discover AMEX

  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 and it's suppliers to check my credit rating if I decide to pay by check.




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