*Fields with an asterisk are required

Please enroll me in The Energy Cooperative's Heating Oil Program

Please switch my heating oil supplier

CONTACT INFORMATION

 Company Name (if applicable)

*First Name 

*Last Name 

*Mailing Address

*City, State, Zip       *County  Select A County Bucks Chester Delaware Montgomery Philadelphia

*Daytime Phone Number (xxx-xxx-xxxx) 

  Evening Phone Number (xxx-xxx-xxxx) 

*Email Address 

  Help us reduce mailing costs and paper usage!  Choose to receive your confirmation, renewal notices, and

  newsletters by email.  We do not share email addresses with others.  Select your preferred contact method Email Mail

DELIVERY INFORMATION

*Choose your supplier:  Select A Supplier Action Fuel Oil Atlantic Coast Energy (B2) Cardinal USA Fuel Oil (B5) Chester County Fuel Oil Hanly Oil (B5) Hanly Oil Inter-County Oil Services Nardello Fuels Rhoads Energy (B5) Rhoads Superior Plus (B5) Worley & Obetz (B20)  

Suppliers with B2, B5 or B20 next to their names deliver Bioheat. For more information, refer to Clean Heat on our website.

   Not sure who to pick?  Make sure you've reviewed the supplier details for the suppliers serving your area.

*Delivery: Select Your Delivery Preference Automatic (not available with Action) Will-Call (minimum gallon requirement, not available with Cardinal in Bucks County)

  Are you interested in a service contract: No Yes

*When do you anticipate contacting your supplier for your first delivery?

  Amount Currently in Tank
 

  Any additional information you think would be helpful for your new supplier to know?

SERVICE INFORMATION

If you have multiple service addresses, please submit an enrollment form for each location.

  Service Address (leave blank if same as mailing address above)

       County Select A County Bucks Chester Delaware Montgomery Philadelphia

  Is your water heated by oil?  Yes No

*Tank Location Basement Outside Underground Unsure

*Describe the location of the fill spout

*Tank Size       275 550 1000 other unsure  

MEMBERSHIP TYPE & DUES

Membership type & dues:

$15 - Households

Any residential household or residential consumer of energy in PA.

$30 - Organizations

Any cooperative organization, credit union, unincorporated association, community association, or nonprofit organization located within PA.

$30 - Businesses

Any businesses or for-profits enterprises (including landlords), located in PA.

Contributions*

Help us continue offering dues waivers to members in need! 

Give an additional:

$15

$30

$45

Other amount

*Please note, because we are a member-owned cooperative and not a 501(c)3, contributions made to The Energy Cooperative are not considered tax-deductible charitable contributions.

Payment method:

Pay online now using a credit card (MasterCard, VISA, Discover)

Note: After you hit the "Submit" button below, you will be directed to a thank you page where you must click on "Pay Online Now" to connect to Click & Pledge, our secure online vendor.

Pay by check

Make check payable to The Energy Cooperative, include Membership Renewal in the memo, and mail to: The Energy Cooperative, 1528 Walnut Street, Suite 2100, Philadelphia, PA  19102

Dues waiver

      Any member in a low-income household or with a very small operating budget may  

      request an annual dues waiver. No proof of income or operating budget is required and

      there are no specific limits.  Please use your own discretion to determine whether you

      would like to request your dues be waived this year.

N/A - My dues are current

TELL US MORE

How did you learn about The Energy Cooperative? Please Select Ad Another Website Friend or Relative Internet search Media Outlet Organization Social Networking Site Other (Please specify below)

What is your reason for membership in the Heating Oil Program?:  Please select Cost savings on heating oil Access to bioheating oil Participation in the co-op movement

If you're switching suppliers, please tell us why:   Please Select Reason For Switching Moved Bad Experience with Previous Supplier Service Options Bioheating Oil Availability Better Pricing Recommendation Other (please specify below)

Please review your information above, print a copy of this page for your records, and then click submit. (It may take a few minutes for the confirmation page to come up.  Please only hit this button once.)

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