​​A fULL SERVICE FUEL OIL COMPANY

​​KEOHAN FUELS & TRANSPORTATION, INC

                                                                 Keohan Fuels & Transportation, Inc.

                                                                      Since 1958                                                                        

New Customer Information Sheet

 
                                              Please fill out ALL of the information below and please PRINT CLEARLY.

Any missing information could delay account setup. 



DATE:______________________________________

 NAME:___________________________________________________________________________________________________________       


 MAILING ADDRESS:___________________________________________ CITY:_____________________________ZIP:____________

SITE ADDRESS:________________________________________________ CITY:_____________________________ZIP:_____________

TEL#______-______-________ CELL#______-______-________  EMAIL:___________________________________________________

ARE YOU: OWNER   TENANT      


If Tenant, LANDLORD NAME:___________________________________________________________________________________

LANDLORD CONTACT #:_______________________________________________________________________________________


 DWELLING:  SINGLE   2 FAMILY   OTHER______________________________________

USE FOR HOT WATER:  YES   NO    (Please do not skip this, it affects deliveries)


TANK SIZE:  138  220  275   330   550  OTHER_______________________________

DELIVERY OPTIONS:  WILL CALL    AUTOMATIC*

*Please provide the last FOUR delivery dates and gallons if choosing automatic. If unavailable please choose will call

  for your first deliveries to establish usage. We need to know how often you will need fuel deliveries when on auto.

DATE:___________ GALLONS:___________             DATE:___________GALLONS:_____________ 


DATE:___________GALLONS:___________              DATE:____________GALLONS:_____________
 
HOW MUCH IS IN TANK NOW_________

FILL LOCATION (STANDING FACING FRONT OF HOUSE) PLEASE BE SPECIFIC THIS IS VERY IMPORTANT.

FOR EXAMPLE IS IT IN THE FRONT OF THE HOUSE OF SIDE OR BACK:___________________________________________

_________________________________________________________________________________________________________________


IS THERE MORE THAN ONE FILL AT THIS LOCATION:  YES    NO            IF YES, IS IT ALSO YOURS:  YES   NO


TYPE OF SYSTEM ( HOT AIR, STEAM, ETC):________________________

AUTOMATIC CREDIT CARD PAYMENTS (OPTIONAL)**   MASTERCARD      VISA      AMERICAN EXPRESS     DISCOVER CARD#:____________________________________________________________EXP. DATE:___________________________________

BILLING ADDRESS FOR CARD: ___________________________________________________________________________________

**Filling out this section implies you want ALL deliveries billed to your card AUTOMATICALY  

     


Once completed, please send to Keohan Fuels & Transportation, Inc. P.O. Box 760684 Melrose, Ma 02176