Easy Customer Application

You are connected to our secure (HTTPS/SSL) server environment. We will create a no obligation new customer account and you will be able to access the best pricing available. Thank you for contacting Chair City Oil, we look forward to the opportunity to serve your heating needs.

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Billing & Mailing Information

Applicant NameMailing Street AddressCityStateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZipPrimary Contact Phone ###-###-####Phone TypeTypeHomeCellCell (Alternative)WorkOtherAlternative Contact Phone ###-###-####Phone TypeTypeHomeCellCell (Alternative)WorkOtherPrimary EmailHow do you wish to receive invoices & statements?Send Invoices & Statements ByEmailMailHow did you find us?How did you find us?RecommendationNewspaper AdTag on FurnaceMailingsPrevious Owner or LandlordInternet SearchOther (please explain)Other

Oil Delivery Location

Do you own or rent this property?Own/RentOwnRentHow long have you owned or rented this property?How LongLess than 1 monthLess than 3 monthsLess than 6 monthsLess than 1 yearLess than 2 yearsLess than 3 yearsMore than 3 yearsName (if different than billing information)Delivery Address (if different than billing information)CityStateStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip

Oil Delivery Information

What's the approximate size of your oil tank?Size Of TankStandard 275330 TankLess than 2502 TanksNot SureOtherWhat is the current approximate oil level?Remaining OilTank is emptyLess than 1/8Less than 1/4Less than 1/2Less than 3/4Almost fullFrom the street where is the tank fill location?Tank Fill LocationIn the front on the leftIn the front on the rightOn the right side towards the frontOn the right side towards the backIn the back on the rightIn the back on the leftOn the left side towards the backOn the left side towards the frontI don't know, but it's the only tank in the houseI don't know, come help me decideHas the tank been inspected?Tank InspectedYesNoNot surePlease make a free inspectionAdditional Location InformationAdd any additional information that will help us locate the correct oil fill.

How Can We Help You?

When will you need your first delivery?First Delivery TimeframeContact me about auto-deliveryAs soon as possibleThis weekThis monthI will call when I need oilWhen do you want us to check your heating system?Heating System Check TimeframeI will call when I need itContact me to provide free evaluationContact me to schedule annual tune-upContact me about services I needI have someone else do serviceAdditional Service InformationAdd any additional information, questions or requests that will help us best serve you.Would you like to be emailed our newsletter?Receive News UpdatesEmail meNo thank you

Would you like to be considered for charge privileges?

Would you like to be considered for charge privileges?Consider Me For Charge PrivilegesYesNoWould you like automatic delivery (if approved)?Automatic DeliveryYesNoWho was your previous fuel supplier?Typed Signature For ApplicantSocial Security NumberBirth Date MM-DD-YYYYTyped Signature For Joint ApplicantSocial Security NumberBirth Date MM-DD-YYYYApplicant(s) Signature: By typing name, I/we consent to a credit check based on the information provided for the purpose of extending credit. Any balance remaining unpaid after thirty (30) days of billing date is subject to a finance charge of 1/2% monthly (18% annual). If legal proceedings become necessary to enforce collection, applicant agrees to pay all reasonable collection and attorney fees.

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