Heating Oil Delivery Verification (Internal)

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Supplier*
Order Date*
MM slash DD slash YYYY
Did you place this order because you were out of oil?*
Delivery Schedule*
Please choose the delivery schedule with which this delivery was made.
Delivery Date*
MM slash DD slash YYYY
Quantity*
Please enter a number from 0 to 99999.999.
Price Per Gallon*
Please enter a number from 0 to 99999.999.
Total Invoice*
Please enter a number from 0 to 99999.999.
Discount Applied?*
Let us know if you were given a discount on your oil delivery.
Discounts Amount
Enter the dollar amount of the discount you received.
Additional Charges Applied?*
Let us know if you were charged anything in addition to the oil delivery charges.
Additional Amount Charged*
Please enter a number from 0 to 99999.999.
Enter the dollar amount for anything you were charged in addition to the oil delivery charges.
Were there any issues with the delivery (besides pricing-related issues)?
Please explain the issue(s) you experienced with your delivery.
Provide any details that might be helpful for us to understand the issue(s) with the delivery or supplier.
Do you want to be contacted regarding your delivery verification?
Sure thing! Please provide the below contact information, and someone will contact you within one business day.
No worries, we will note your response for our records. Thank you for being a member!
Preferred Contact Method
Phone
Email
Staff Member*

Have questions? Give us a call at 215.413.2122.