*Fields with an asterisk are required

Please enroll me in The Energy Cooperative's Heating Oil Program

Please switch my heating oil supplier

CONTACT INFORMATION

  Business/Organization

*First Name 

*Last Name 

*Mailing Address

*City, State, Zip       *County  Select A County Bucks Chester Delaware Montgomery Philadelphia

*Daytime Phone Number (xxx-xxx-xxxx) 

  Evening Phone Number (xxx-xxx-xxxx) 

*Email Address 

  Help us reduce mailing costs and paper usage!  Choose to receive your confirmation, renewal notices, and

  newsletters by email.  We do not share email addresses with others.  Select your preferred contact method Email Mail

SUPPLIER INFORMATION

*Enroll me with: Select A Supplier Action Fuel Oil Cardinal USA Fuel Oil Chester County Fuel Oil Hanly Oil Inter-County Oil Services Nardello Fuel Oil Patriot Fuel Oil Rhoads Energy Superior Plus Energy Services Worley & Obetz  

  Not sure who to pick?  Make sure you've reviewed the supplier details for the suppliers serving your area.

  Bioheating Oil (only available with Cardinal, Hanly, Rhoads, or Worley & Obetz): No Yes

*Pricing: Co-op Floating Daily Rate Other Supplier Payment Plan

*Delivery: Select Your Delivery Preference Automatic (not available with Action) Will-Call (minimum gallon requirement)

*Payment Method (subject to supplier approval and availability):   Select Your Payment Preference COD Standard Billing Credit Card EFT LIHEAP

  Are you interested in a service contract: No Yes (not available with Action)

SERVICE INFORMATION

If you have multiple service addresses, please submit an enrollment form for each location.

  Service Address (leave blank if same as mailing address above)

     County Select A County Bucks Chester Delaware Montgomery Philadelphia

*Describe the location of the fill spout

*Tank Size 275 550 1000 other unsure       Amount Currently in Tank

  Is your water heated by oil?  No Yes

*When do you anticipate contacting your supplier for your first delivery?

Any additional information you think would be helpful for us or your new supplier to know?

MEMBERSHIP TYPE & DUES

Membership type & dues:

$30 - Class A: Organizations

Any cooperative organization, credit union, unincorporated association, community association, or nonprofit organization located within PA.

$15 - Class B: Households

Any residential household or residential consumer of energy in PA.

$30 - Class C: Businesses

Any businesses or for-profits enterprises (including landlords) not in Class A, located in PA.

Please note, The Co-op is still absolutely committed to providing memberships free of charge without requiring proof of income or setting specific income limits.  If you are in a low-income household (Class B members) or have a very small operating budget (Class A or C), please select your appropriate membership type from above and "Dues waiver" under payment type below. Even if requesting a dues waiver, you will be asked to renew your membership annually. 

Contributions*

Help us continue offering dues waivers to members in need! 

Give an additional:

$15

$30

$45

Other amount

*Please note, because we are a member-owned cooperative and not a 501(c)3, contributions made to The Energy Cooperative are not considered tax-deductible charitable contributions.

Payment method:

Pay online now using a credit card (MasterCard, VISA, Discover)

Note: After you hit the "Submit" button below, you will be directed to a thank you page where you must click on "Pay Online Now" to connect to Click & Pledge, our secure online vendor.

Pay by check

Make check payable to The Energy Cooperative, include Membership Renewal in the memo, and mail to: The Energy Cooperative, 1528 Walnut Street, Suite 2100, Philadelphia, PA  19102

Dues waiver

N/A - My dues are current

How did you learn about The Energy Cooperative? Please Select I'm a Current Member Friend or Relative Internet search Mailing from the Co-op Newspaper PA Interfaith Climate Change Campaign Public Utility Commission/Office of Consumer Advocate Radio discussion RecycleBank Sustainable Business Network Utility Choice Weavers Way Co-op Other (Please specify below)

Please select your primary reason for enrolling or remaining a member:  Please select Cost Savings Recommended by Friend or Relative Access to Bioheating Oil Involvement in Co-op Movement Other (please specificy below)

If you're switching suppliers, please tell us why:   Please Select Reason For Switching Lower Price Per Gallon Service Options Experience with Previous Supplier Change of Location or Supplier Availability Bioheating Oil Availability Range of Options Recommendation Other (please specify below)

Please review your information above, print a copy of this page for your records, and then click submit. (It may take a few minutes for the confirmation page to come up.  Please only hit this button once.)

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