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Oil Delivery Application
Oil Delivery Application
genoveadmin
2022-05-31T16:00:08+00:00
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Date of Application
*
Source of Referral
Choose One
Angie's List
Facebook
Genove customer, employee, friend etc..
Google
Green Energy
LinkedIn
Mass Energy
Twitter
Web Search
Yelp
Other
Name
*
First
Last
Delivery Street Address
*
Delivery City
*
State
*
MA
Zip Code
*
Choose Single or Multi-Family
*
Single Family
Multi-Family
Billing Address Same as Delivery?
Yes
No
Billing Street Address
Billing City
Billing State
MA
Billing Zip Code
Choose Own or Rent
Own
Rent
How Long Own/Rent
Lease End Date
Landlord/Mortgage Holder Address & Phone# if different from above
Former Address - if less than 3 years at current address
Cell Phone
*
Home Phone
Business Phone
Email
*
Employer Name
*
Employer Address
*
Position
How Long
Emergency Contact Name
*
Emergency Contact Address
Emergency Contact Phone #
*
Type of Payment Plan Requested
*
Auto Credit Card
Net 30 Days
Budget
Other
Other Payment
*** For All Applicants: Please call the office (781-893-9191) with Credit Card Information.***
Statements/Invoices
Email
Paper
Former Supplier
Did we deliver to previous Occupant?
Yes
No
Current Fuel Level
*
Hot Water By Oil
Yes
No
Estimated Annual Consumption
Service Plan
Yes
No
Sign Up For Service Plans - check all that apply
Platinum
Gold
Natural Gas
AC
Automatic Delivery
Yes
No
Number of Tanks and Size
Where is your oil fill? Check the diagrams below for ALL Locations.
0
1
2
3
4
5
6
7
8
9
Apartment or Home Square Footage
Do you have central air conditioning?
Yes
No
Electronic Signature: Check "YES to sign this Application
*
YES Electronic Signature
Comment
Submit
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