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First Name * Last Name * Cell Number * Email * Address * City * State * -- Select State --VTNH Zip Code * House Color * Type of House * Mailing Address * Mailing City * Mailing State * -- Select State --VTNH Mailing Zip Code *

Price Per Gallon: $3.65

Price is not guaranteed, may change at time of delivery

Gallons * Fill Up1001251501752002252503003504004505006007008009001000 Tank Size * -- Select Tank Size * --2753305501000Other Tank Level * -- Select Tank Level * --1/2 (Half)1/4 (Quarter)1/8 (Eight)E (Almost empty)?? (Not sure) Fill Pipe * -- Select Fill Pipe Location * --ABCDEFGH Oil Usage * -- Select Oil Use --Heat OnlyHot Water OnlyHeat and Hot Water Delivery Instructions Credit Card Number * Expiration Month * -- Select Month (required) --01 - January02 - February03 - March04 - April05 - May06 - June07 - July08 - August09 - September10 - October11 - November12 - December Expiration year * -- Select Year (required) --202220232024202520262027202820292030 Security Code *