City Fuel open account

603-669-3033 for 24 hour assistance

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Open Account

*required fields

Full Name *:
Spouse's Name:
Telephone *:
Email *:
Delivery Address *:
Delivery City *:
Delivery State *:
Delivery Zip *:
Billing Address *:
Billing City *:
Billing State *:
Billing Zip *:
Owner or Rent:
Landlords Name:
Previous Oil Dealer:
Free efficiency and tank test for automatic accounts only?:
Is Oil used to heat your hot water?:	Yes No
Where is your fill pipe (as if you are directly facing your house)?:
Fuel needed:	Home Heating Oil Kerosene
Do you wish to have automatic delivery?:	Yes No
Special delivery notes:
Tank size (Average 275):
By checking this box you are hereby authorized to make any investigations concerning my financial standing and/or credit record through any investigative or credit reporting agencies. I/we agree to pay all reasonable costs of collections, including lawyer fees for any outstanding balances.

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