Allen's Oil & Propane - Customer Application

CUSTOMER INFORMATION
NAME:*
ADDRESS:*
CITY/ST/ZIP:*
HOME PHONE:
CELL PHONE:
WORK PHONE:
EMAIL:*
OWN OR RENT?:

OWN RENT
DID SOMEONE REFER YOU?:

YES NO
IF "YES", WHO?:
DELIVERY INFORMATION
DELIVERY ADDRESS:*
CITY/ST/ZIP*
DELIVERY INSTRUCTIONS:
FUEL TANK SIZE:
PROPANE TANK SIZE:
LOCATION:
PRODUCT/SYSTEM:
FILL LOCATION:
(SEE CHART TO THE RIGHT)
FILL PREFERENCE W/C @30% or ALLOW 3-4DAYS FOR DELIVERY:
INFORMED R.O. CHARGES:*
PROPANE USE
APROX. GALLONS IN TANK:
YEARLY GALLONS:
ADDITIONAL HEATING SOURCE:

HEAT PUMP KEROSENE HEATER WOOD STOVE
SERVICE INFORMATION
SERVICE AGREEMENT:
BUDGET PLAN:
HEATER:
HWG:
DELIVERY NEEDED ASAP:
ACCEPT RETAIL CREDIT AGREEMENT*

I ACCEPT
Should be Empty:

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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: 609-561-5668

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