* Denotes Required Field

First Name:*

Last Name:*

E-Mail Address:*

Account Number (If Applicable):

Company Name (If Applicable):

Delivery Address:*

Phone #:*

Payment Method:*

Credit/Debit Card
Cash on Delivery
Check on Delivery

Products:*

Fuel Oil #2
Propane
Kerosene
Diesel (Off Road) - Ultra Low Sulfur
Diesel (On Road) - Ultra Low Sulfur
Service ONLY

Gallons Needed (Min order may apply):

OR

Fill Tank

Type of Equipment:

Oil Furnace
Oil Boiler
Gas Boiler
Propane or Gas Furnace
Air Conditioning
Heat Pump (Electric Heat)

Service Issue:

No Heat
No Cooling
System not working properly
Thermostat not working properly
Schedule a Tune-Up (a rep will call you)
Enroll in Service Plan (a rep will call you)
Free Energy Audit/Estimate on new equipment
Other (I will specify in messages section below)

Would you like information about a service contract which can save you up to 10% in your home energy bill?:

Yes
No

Would you like a Berico Representative to call you about your order?:*

Yes
No

Message or Special Delivery Instructions:

Preferred Company:

Alamance Oil - Alamance County Area
Carolina Fuels - Rockingham / Caswell / Stokes County Area
Berico Fuels - Greater Greensboro Area

Please fill in the above code for security purposes.*