Automatic Delivery Application Fields marked with an * are required Please enable JavaScript in your browser to complete this form.Name *Full Address *Phone Number *Email Address *1. How many gallons of heating oil did you use last year? *2. How much oil is in your tank now? Gauge reading: *3. Is oil your primary source of heat? *YesNo4. Do you have an alternate source of heat? *YesNo5. Do you use heating oil for hot water? *YesNoOnly in Winter6. What color is your house? *7. Do we have permission to use your driveway? *YesNo8. What size is your tank? *9. Is access to the fill pipe restricted in bad weather? (ice & snow) *YesNo10. Looking at your house from the street, where is the fill pipe located? *FrontBackLeftRightFront - LeftBack - LeftFront - RightBack - RightGarageOtherI authorize G&G Oil Company to run a pre-authorization on my credit card prior to the delivery and process the full payment once the delivery is made. *YesSignature: By signing below I understand and agree to the terms and conditions set forth in this agreement. (First Name, Last Name, & Date) *Anything else we should know?WebsiteSubmit
