What is your main source of heat?                                              #2 Fuel         Kerosene/Stove Oil

Do you use this product to heat your domestic hot water?         Yes                No
      Would your like your tank to be automatic filled?               Yes      

Or would you prefer to call us when you need fuel? (please give us 3-4 days notice to schedule your delivery)         Yes     



I (We) herby authorize the delivery of various petroleum products as may from time to time be delivered at the undersigned's request or prursuant to an automatic delivery schedule.
NOTICE TO THE BUYER(S): YOU ARE ENTITLED TO A COPY OF THE AGREEMENT AT THE TIME YOU SIGN. KEEP IT TO PROTECT YOUR LEGAL RIGHTS.

BUYERS SIGNATURE