Order as Guest – AJs Discount Oil

Guest Order Form

New or Returning Customer?

New Returning

Business or Residence

Business Residence

First Name

Last Name

Other Name on Account

Street Address

Town

Type of Building

Primary Phone

Alternate Phone

Tank Size

Order Amount in Gallons (enter FILL to fill your tank)

More than One Fill Pipe

Yes No

Fill Pipe Location - Select the number closest to the location on your building

Fill Pipe Location Notes

Is the Fill Pipe Accessible (free of snow and cleared path)

Yes No

Payment Method

Where will you leave payment?

Special Instructions