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Schedule Automatic Delivery
Schedule Automatic Delivery
codoillongisland
2020-06-06T01:52:04+00:00
Your Name:
*
Phone:
*
Email:
*
Delivery Address:
*
Town:
*
Zipcode:
*
Tank Location:
*
Tank Size:
*
Tank is:
*
Outside
Basement/Crawl Space
Inground/Buried
Start delivering on:
*
Date Format: MM slash DD slash YYYY
Average Usage Per Year (If Known):
Special Instructions:
Deliveries during cold season (November-March)
How often would you like a delivery?
*
----Please Select----
Schedule me automatically
Once every 2 weeks
Once every 3 weeks
Once every 4 weeks
Once every 5 weeks
Once every 6 weeks
Once every 7 weeks
Once every 8 weeks
How many gallons per delivery?
*
----Please Select----
Fillup
50 gallons
100 gallons
150 gallons
200 gallons
250 gallons
300 gallons
500 gallons
1000 gallons
Deliveries during warm season (April-October)
How often would you like a delivery?
*
----Please Select----
Schedule me automatically
Once every 4 weeks
Once every 8 weeks
Once every 12 weeks
Once every 16 weeks
How many gallons per delivery?
*
----Please Select----
Fillup
50 gallons
100 gallons
150 gallons
200 gallons
250 gallons
300 gallons
500 gallons
1000 gallons
Payment Information:
Your card will be charged on the day of, or 1 day before delivery. Refunds will be automatically processed, should you take less gallons. Your billing address must match your delivery address. If your billing address is different, please call our office at (516) 218-5109 after submitting the form.
Card Number:
*
Expiration Date:
*
CVV:
*
3 numbers on the back / Amex 4 numbers on front
Terms of Service
*
I agree to the
Terms of Service
Email Notification:
I'd like to receive email notification before each delivery
