If you would like to setup an account with us, please fill out the form below and return it to us. Once we receive it, we will contact you to schedule your first delivery. A quick tank inspection is required for all new accounts. Our driver will need access to your oil tank just before making your first delivery. This is only required for the first delivery.
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 will delay account setup. If setting up more than one account, please fill out a form for EACH account. Do NOT use one form for multiple accounts.
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, FORCED HOT WATER, STEAM, ETC):________________________________________________
AUTOMATIC CREDIT CARD PAYMENTS** MASTERCARD VISA AMERICAN EXPRESS DISCOVER CARD#:____________________________________________________________EXP. DATE:___________________________________
BILLING ADDRESS FOR CARD: ___________________________________________________________________________________
**THIS IS REQUIRED FOR ALL NEW ACCOUNTS. PLEASE CONTACT OUR OFFICE IF YOU WOULD LIKE TO PAY BY
ANOTHER METHOD.
Once completed, please send to Keohan Fuels & Transportation, Inc.880 Main Street Wilmington, MA 01887
A fULL SERVICE FUEL OIL COMPANY
KEOHAN FUELS & TRANSPORTATION, INC