​​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.



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    TANK SIZE:  138  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.

DATES: _________________________________________GALLONS:__________________________________________

HOW MUCH IS IN TANK NOW_______________________________________________________________________

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

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