DepewOil.com - Automatic Delivery Application

Name * First Last

Account Number (if applicable)

Email *

Promo Code

Name of Employer *

Number of years employed *

Directions

New automatic delivery customers or existing automatic delivery customers with changes to delivery information.

Please include the color of the house and any distinctive features of your property

We will need your last 2 oil delivery dates and the amount of gallons taken to figure your past usage. If you are unable to provide this information, we will schedule your first two deliveries.

Date of Fill *

Amount of Gallons *

Date of Fill *

Amount of Gallons *

**Reminder: Please clear a path to the fill pipe during snow and ice conditions.

Automatic Delivery Customers require a credit card guarantee. If you are not a budget customer, Depew Energy Co. invoices must be paid within 14 days. If your balance is not paid, we reserve the right to bill any credit card on your account without notification. If you have a balance on your account, and your credit card is declined, you will not receive a second delivery. If you run out of fuel, or your fuel situation becomes an emergency because of lack of payment, you will be charged standard emergency delivery fees. The customer is responsible for keeping their driveway clear of snow and ice. If we are unable to deliver because of hazardous conditions, we will call the customer once, and then come back. Additional returns after that one become payable charges. New customers will have their credit card charged after the first two deliveries. By signing this contract the customer agrees to all payment terms of Depew Energy Co.

Digital Authorization Customer Signature *

Wufoo

**Reminder: Please clear a path to the fill pipe during snow and ice conditions.