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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? Refer to the diagram below for ALL Locations.
*
Front of House - Front left
Side of House - Left
Back of House - Back left
Front of House - Front right
Side of House - Right
Back of House - Back right
Reference Diagram
Diagram
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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