791-2825
791-BUCK
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ABOUT
DELIVERY AREA
CONTACT US
ORDER OIL
MY ACCOUNT
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Guest Order Form
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New or Returning Customer?
New
Returning
Business or Residence
Business
Residence
First Name
Last Name
Other Name on Account
Street Address
Town
PLEASE SELECT
Cape Elizabeth
Cumberland
Falmouth
Portland
South Portland
Westbrook
Yarmouth
Type of Building
Single Family Home
Duplex
Aparttment
Primary Phone
Alternate Phone
Tank Size
PLEASE SELECT
275
330
500
550
660
1000
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
PLEASE SELECT
1
2
3
4
5
6
7
8
Fill Pipe Location Notes
Is the Fill Pipe Accessible (free of snow and cleared path)
Yes
No
Payment Method
PLEASE SELECT
Check
Cash
Money Order
Credit / Debit card
Where will you leave payment?
PLEASE SELECT
Envelope Taped to Fill Pipe
Envelope Taped to Front Door
Envelope Taped to Side Door
Envelope Taped to Back Door
Under Front Doormat
Under Side Doormat
Under Back Doormat
I will call the office to provide credit/debit card information
Special Instructions
ORDER