​            ​​A fULL SERVICE FUEL OIL COMPANY

​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

​

​​

     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 (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