OIL DELIVERY REQUEST

For non-emergency oil deliveries, feel free to utilize the following form for your request. Please note that completion of this form does not constitute a guarantee of delivery. All online requests will be reviewed and processed on the next business day. There is a 150 gallon minimum on all deliveries on a COD basis. Payments can be made by cash, check or credit card (Visa, MC, Discover).

Please complete all required fields:
(* denotes required fields)
First Name *


Last Name *


Address


City


State


Zip


Email *
Phone *


Cell Phone


Delivery Date - Note: All deliveries made next business day


Fill Location


Tank Size


Amount (150 gallon minimum)


Payment Method (Our office will call you if paying by credit card)
Special Instructions - If paying by check, leave check location.

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Copyright ©2010
Office: 203-880-9267,
Toll Free: 1-866-214-0124,
info@polarenergyct.com

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