Please complete all information requested on this form. Orders Customer: —Please choose an option—NewExisting Name: (required) Type of Service: —Please choose an option—Heating OilDieselOff-Road DieselService Gallons Ordered: Fill Location: Email (required) Check here to receive email updates Complete Street Address: (required) Nearest Intersection (This helps our drivers find you!): Best Phone Number: Additional Directions or Instructions: Select a Payment Method: —Please choose an option—Payment Method on FileCall me for Payment MethodI Will Call Your Office with Payment Method *Daniel Family Fuel is a full service home heating oil company dedicated to quality and service. Δ