Fuel Oil Online Order Form 1 Customer Information2 Order Information3 Payment Information Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Account Number (If known)Have you ordered from us in the past?*YesNoPlease provide directions, tank information and tank location to your home What type of fuel would you like to order?* #2 Heating Oil (For indoor or underground tanks) Kerosene (Outside - Above ground tanks) #2 With Additive (For outdoor aboveground tanks - prevents gelling in extreme temperatures) Additional $0.03 / gallon 70/30 Mix (Outside - Above ground tanks) 50/50 Mix (Outside - Above ground tanks) Quantity Requested*How many gallons needed?Would you like your tank filled?*YesNoEstimated Tank Capacity*Please give an estimate as to how many gallons of fuel your tank can hold.Are you currently out of fuel?*YesNoClick Here to View Tank Size ChartDelivery Date*If a date is not selectable then we are not accepting deliveries for that day. Date Format: MM slash DD slash YYYY Delivery Schedule from Kittaning: Mondays: 422 West, 268 and 68 North, Zelienople Tuesdays: 66 and 28 North Wednesdays: 66 and 28 South, Zelienople Thursdays: 66 and 28 North Fridays: 85 and 422 East, Zelienople Payment Method*CheckCashCredit CardUse existing credit on an account This iframe contains the logic required to handle Ajax powered Gravity Forms.
